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Updated: Sep 6, 2025

Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head
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Insulinoma-Accurate Preoperative Localization Is the Key to Management: An Initial Experience.

Ajay Sharma1, Peeyush Varshney2, Rajeev Kasliwal3

  • 1Department of Surgical Gastroenterology, Mahatma Gandhi Medical College and Hospital, Jaipur, 302022 India.

Indian Journal of Surgical Oncology
|July 5, 2022
PubMed
Summary
This summary is machine-generated.

Accurate preoperative localization is key for successful insulinoma surgery. While multi-detector computed tomography (MDCT) is effective, Ga 68 NOTA-exendin-4 PET-CT (GLP1R scan) offers a vital alternative when other methods fail.

Keywords:
EnucleationGa 68 NOTA-exendin-4 PET-CTInsulinomaPancreatic neuroendocrine tumor

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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Diagnostic Imaging

Background:

  • Insulinoma, the most common functioning pancreatic neuroendocrine tumor, requires surgical excision for cure.
  • Preoperative tumor localization is critical for successful surgical outcomes.
  • Pancreatic neuroendocrine tumors (PNETs) present unique diagnostic and therapeutic challenges.

Purpose of the Study:

  • To evaluate the efficacy of various preoperative localization techniques for insulinoma.
  • To assess surgical outcomes and postoperative complications following insulinoma resection.
  • To determine the optimal surgical approach and confirm the importance of accurate preoperative localization.

Main Methods:

  • Retrospective analysis of nine insulinoma patients (February 2017-June 2020).
  • Utilized multi-detector computed tomography (MDCT), endoscopic ultrasound (EUS), Ga 68 DOTANOC PET-CT, and Ga 68 NOTA-exendin-4 PET-CT (GLP1R scan) for localization.
  • Surgical resection included enucleation, distal pancreatectomy with splenectomy, and pancreatoduodenectomy (PD), with both open and laparoscopic approaches.

Main Results:

  • MDCT localized tumors in 8/9 patients; EUS was successful in one case.
  • Ga 68 DOTANOC PET-CT detected tumors in 2/4 patients, while GLP1R scan accurately localized a tumor missed by MDCT and DOTANOC PET-CT.
  • All patients achieved a cure, with laparoscopic surgery proving effective. Postoperative pancreatic fistula occurred in five patients, with one requiring intervention.

Conclusions:

  • Accurate preoperative localization is paramount for achieving surgical cure in insulinoma patients.
  • MDCT is highly effective, but GLP1R scan serves as a crucial last resort for localization.
  • Laparoscopic resection is a safe and effective alternative to open surgery, with tumor enucleation being the preferred method for benign insulinomas.