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Pancreatic insulinomas. A 15-year experience
1Department of Surgery, University of Hong Kong, Queen Mary Hospital, People's Republic of China.
Archives of Surgery (Chicago, Ill. : 1960)
|August 1, 1997
Summary
Management of pancreatic insulinomas requires effective localization. Intraoperative methods successfully identified tumors missed preoperatively, leading to cures for benign cases but significant morbidity.
Area of Science:
- Endocrinology
- Surgical Oncology
- Gastroenterology
Background:
- Pancreatic insulinomas are rare neuroendocrine tumors causing hypoglycemia.
- Accurate preoperative localization is crucial for successful surgical management.
- Previous studies highlight challenges in localizing small or occult insulinomas.
Purpose of the Study:
- To review the experience with pancreatic insulinoma management.
- To emphasize the importance of preoperative localization techniques.
- To evaluate the outcomes of surgical treatment for insulinomas.
Main Methods:
- A case series of 27 patients with pancreatic insulinomas treated surgically.
- Analysis of preoperative localization methods: ultrasonography, computed tomography, angiography, and venous sampling.
- Evaluation of intraoperative localization techniques, including palpation and intraoperative ultrasonography.
Main Results:
- Preoperative localization accuracy varied: ultrasonography (33%), CT (44%), angiography (52%).
- Venous sampling achieved 90% tumor regionalization; intraoperative ultrasonography identified nonpalpable tumors.
- Surgery resulted in euglycemia in 25 patients, curing all benign insulinomas but only 33% of malignant cases. Morbidity was 33%.
Conclusions:
- Intraoperative localization is effective for pancreatic insulinomas, even with failed preoperative studies.
- Surgical treatment offers a cure for benign insulinomas but is associated with significant morbidity.
- Malignant insulinomas have a lower cure rate, underscoring the need for comprehensive management strategies.