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2012 | 84 | 1 | 31-36
Article title

Surgical Treatment of Hyperinsulinism During the Course of Pancreatic Cancer (Insulinoma) - One Center Experience

Content
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EN
Abstracts
EN
Endogenic hyperinsulinism is mainly caused by neuroendocrine tumors (insulinomas) which autonomously secrete insulin. Because the symptoms are often aspecific, a considerably delay in diagnosis occurs. The treatment consists of operative removal of the tumor from the pancreas, preceded by pre-operative localization. In this article we describe our experience with surgical removal of insulinomasMaterial and methods. We retrospectively analyzed all patients with insulinoma which were treated in our center. Definitive diagnosis was made using a 72-hours glucoses fasting test. We describe the symptoms, localization techniques and the outcomes after surgery.Results. Between January 2002 and May 2011, 45 patients (35.6% men and 64.4% female) were treated in our center. The most prevalent symptoms were altered consciousness and general malaise. The combination of CT-scan and endoscopic ultrasound had the highest (90%) sensitivity to localize tumors pre-operatively. During surgery, in 40 patients (89%) the tumor could be removed by enucleation. In the other five patients partial pancreas resection was required. In 22 patients (49%) we used intra-operative insulin level measurements to confirm complete tumor resection. Within the first month after surgery, two patients (4.4%) developed acute pancreatitis, four patients (8.8%) developed a pancreatic fistula. One patient died of multi-organ-failure. All patients were free from symptoms of hyperinsulinism after the surgery and after a median follow-up of 4.5 years.Conclusions. Based on the experience with 45 patients, surgical removal, aided by pre-operative localization with CT and endoscopic ultrasonography, is an effective and safe treatment for insulinomas.
Publisher

Year
Volume
84
Issue
1
Pages
31-36
Physical description
Dates
published
1 - 1 - 2012
online
3 - 4 - 2012
Contributors
  • Department of General, Vascular and Transplant Surgery, Warsaw Medical University
author
  • Department of General, Vascular and Transplant Surgery, Warsaw Medical University
  • Department of General, Vascular and Transplant Surgery, Warsaw Medical University
  • Department of General, Vascular and Transplant Surgery, Warsaw Medical University
References
  • de Herder WW: Insulinoma. Neuroendocrinology 2004; 80: 20-22.
  • Dizon AM, Kowalyk S, Hoogwerf BJ: Neuroglycopenic and Other Symptoms in Patients with Insulinomas. Am J Med 1999; 106: 307-10.
  • Marek B, Kajdaniuk D, Kos-Kudła B i wsp.: Insulinoma - diagnostyka i leczenie. Endokrynol Pol 2007; 1: 58-62.
  • Service FJ, Natt N: The prolonged fast. J Clin Endocrinol Metab 2000; 85 (11): 3973-74.
  • Van Hoe L, Gryspeerdt S, Marchal G et al.: Helical CT for the preoperative localization of islet cell tumours of the pancreas: value of arterial and parenchymal phase images. AJR Am J Roentgenol 1995; 165: 1437-39.
  • King AD, Ko GTC, Yeung VTF: Dual phase spiral CT in thedetection of small insulinomas of the pancreas. Br J Radiol 1998; 71: 20-23.
  • McLean AM, Fairclough PD: Endoscopic ultrasound in the localisation of pancreatic islet cell tumours. Best Prac Research Clin Endocrin Metab 2005; 19: 177-93.
  • Gouya H, Vignaux O, Augui J et al.: CT, endoscopic sonography, and a combined protocol for preoperative evaluation of pancreatic insulinomas. AJR 2003; 181: 987-92.
  • Doherty GM, Doppman JL, Shawker TH: Results of a prospective strategy to diagnose, localize and resect insulinomas. Surgery 1991; 110 (6): 989-96.
  • Rothmund M, Angelini L, Brunt M: Surgery for benign insulinomas: an international review. World J Surg 1990; 14 (3): 393-98.[Crossref][PubMed]
  • Wilder RM, Allan FN, Power MH et al.: Carcinoma of the islands of the pancreas: hyperinsulinism and hypoglycemia. J Am Med Assoc 1927; 89: 348-55.
  • Hashimoto LA, Walsh RM: Preoperative localization of insulinoma is not necessary. J Am Coll Surg 1999; 189: 368-73.
  • Wong M, Isa S.H, Zahiah M.K. et al.: Intraoperative ultrasound with palpation is still superior to intra-arterial calcium stimulation test in localizing insulinoma. World J Surg 2007; 31: 586-92.[WoS]
  • Proye C, Pattou F, Carnaille B et al.: Intraoperative insulin measurement during surgical management of insulinomas. World J Surg 1998; 22: 1218-24.
  • Hirshberg B, Libutti S.K, Alxander R et al.: Blind distal pancreatectomy for occult insulinoma, an inadvisable procedure. J Am Coll Surg 2002; 194: 761-64.
  • Muir JJ, Endres SM, Offord K et al.: Glucose management in Patients undergoing operation for insulinoma removal. Anesthesiology 1983; 59: 371-75.
  • Dobrowolski S, Śledziński Z, Sworczyk K i wsp.: Chirurgiczne leczenie guzów neuroendokrynnych trzustki. Pol Przegl Chir 2010; 82 (7): 733-40.
Document Type
Publication order reference
Identifiers
YADDA identifier
bwmeta1.element.-psjd-doi-10_2478_v10035-012-0005-4
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