Insulinoma surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2], Parminder Dhingra, M.D. [3]

Overview

Surgery is the mainstay of treatment for insulinoma. It can be 80 to 100% curative in experienced surgical hands. The feasibility of surgery depends on the stage of insulinoma at diagnosis.

Surgery

Surgery is the mainstay of treatment for benign and resectable malignant insulinoma. It can be 80 to 100% curative in experienced surgical hands.^[1]^[2]

Benign Tumors

Small well-encapsulated, solitary tumors:^[1]^[2]^[3]

Tumors are localized with palpation in 70 % cases during surgery. Intra-operative ultrasound (IOUS) localizes in 86% of times. Palpation and IOUS together localize tumor in 83-98% cases.^[4]^[5]

Insulinoma. By Edward Alabraba et al. – Pancreatic insulinoma co-existing with gastric GIST in the absence of neurofibromatosis-1. World Journal of Surgical Oncology 2009, 7:18doi:10.1186/1477-7819-7-18, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=6686376

Surgical resection is the treatment of choice. Minimal invasive surgery such as laparoscopic surgery is preferred especially for small and solitary benign insulinomas.

Multiple, unencapsulated, > 4 cm in diameter, and involves or is near the main pancreatic duct:

Radical resection

Insulinomas which are associated with MEN1, excision of tumor found in the head of the pancreas plus a distal subtotal pancreatectomy is recommended.^[7]
For occult insulinomas, blind distal pancreatectomy is not advisable. ^[8]

Malignant Tumors

Resectable tumors:^[1]^[2]^[3]

Aggressive surgical resection, including extended pancreatic resection with lymph nodes, liver resection, and/or liver transplantation
Post-surgical chemoembolization or radiofrequency ablation of tumors to control hypoglycemia.

Unresectable tumors

Octreotide administration
Continuous glucose monitoring
Radiofrequency ablation
Embolization
Intra-arterial chemotherapy

Indications

Repeated and prolonged symptoms of hypoglycemia

References

↑ ^1.0 ^1.1 ^1.2 Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y; et al. (2013). “Diagnosis and management of insulinoma”. World J Gastroenterol. 19 (6): 829–37. doi:10.3748/wjg.v19.i6.829. PMC 3574879. PMID 23430217.
↑ ^2.0 ^2.1 ^2.2 Inulinoma. national library of medicine. https://www.nlm.nih.gov/medlineplus/ency/article/000387.htm
↑ ^3.0 ^3.1 Service FJ, McMahon MM, O’Brien PC, Ballard DJ (1991). “Functioning insulinoma–incidence, recurrence, and long-term survival of patients: a 60-year study”. Mayo Clin Proc. 66 (7): 711–9. PMID 1677058.
↑ Norton JA, Cromack DT, Shawker TH, Doppman JL, Comi R, Gorden P; et al. (1988). “Intraoperative ultrasonographic localization of islet cell tumors. A prospective comparison to palpation”. Ann Surg. 207 (2): 160–8. PMC 1493387. PMID 2829761.
↑ Nikfarjam M, Warshaw AL, Axelrod L, Deshpande V, Thayer SP, Ferrone CR; et al. (2008). “Improved contemporary surgical management of insulinomas: a 25-year experience at the Massachusetts General Hospital”. Ann Surg. 247 (1): 165–72. doi:10.1097/SLA.0b013e31815792ed. PMC 3806046. PMID 18156937.
↑ Vázquez Quintana E (2004). “The surgical management of insulinoma”. Bol Asoc Med P R. 96 (1): 33–8. PMID 15575328.
↑ Demeure MJ, Klonoff DC, Karam JH, Duh QY, Clark OH (1991). “Insulinomas associated with multiple endocrine neoplasia type I: the need for a different surgical approach”. Surgery. 110 (6): 998–1004, discussion 1004-5. PMID 1684067.
↑ Hirshberg B, Libutti SK, Alexander HR, Bartlett DL, Cochran C, Livi A; et al. (2002). “Blind distal pancreatectomy for occult insulinoma, an inadvisable procedure”. J Am Coll Surg. 194 (6): 761–4. PMID 12081066.

Template:WikiDoc Sources

[pmid23430217-1] 1.0 ^1.1 ^1.2 Okabayashi T, Shima Y, Sumiyoshi T, Kozuki A, Ito S, Ogawa Y; et al. (2013). “Diagnosis and management of insulinoma”. World J Gastroenterol. 19 (6): 829–37. doi:10.3748/wjg.v19.i6.829. PMC 3574879. PMID 23430217.

[surgery-2] 2.0 ^2.1 ^2.2 Inulinoma. national library of medicine. https://www.nlm.nih.gov/medlineplus/ency/article/000387.htm

[pmid1677058-3] 3.0 ^3.1 Service FJ, McMahon MM, O’Brien PC, Ballard DJ (1991). “Functioning insulinoma–incidence, recurrence, and long-term survival of patients: a 60-year study”. Mayo Clin Proc. 66 (7): 711–9. PMID 1677058.

[pmid2829761-4] Norton JA, Cromack DT, Shawker TH, Doppman JL, Comi R, Gorden P; et al. (1988). “Intraoperative ultrasonographic localization of islet cell tumors. A prospective comparison to palpation”. Ann Surg. 207 (2): 160–8. PMC 1493387. PMID 2829761.

[pmid18156937-5] Nikfarjam M, Warshaw AL, Axelrod L, Deshpande V, Thayer SP, Ferrone CR; et al. (2008). “Improved contemporary surgical management of insulinomas: a 25-year experience at the Massachusetts General Hospital”. Ann Surg. 247 (1): 165–72. doi:10.1097/SLA.0b013e31815792ed. PMC 3806046. PMID 18156937.

[pmid15575328-6] Vázquez Quintana E (2004). “The surgical management of insulinoma”. Bol Asoc Med P R. 96 (1): 33–8. PMID 15575328.

[pmid1684067-7] Demeure MJ, Klonoff DC, Karam JH, Duh QY, Clark OH (1991). “Insulinomas associated with multiple endocrine neoplasia type I: the need for a different surgical approach”. Surgery. 110 (6): 998–1004, discussion 1004-5. PMID 1684067.

[pmid12081066-8] Hirshberg B, Libutti SK, Alexander HR, Bartlett DL, Cochran C, Livi A; et al. (2002). “Blind distal pancreatectomy for occult insulinoma, an inadvisable procedure”. J Am Coll Surg. 194 (6): 761–4. PMID 12081066.

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