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August 1997

Pancreatic InsulinomasA 15-Year Experience

Author Affiliations

From the Departments of Surgery (Drs Lo, Tung, and Fan), Pathology (Dr K.-Y. Lam), and Medicine (Drs Kung and K. S. L. Lam), The University of Hong Kong, Queen Mary Hospital, Hong Kong, People's Republic of China.

Arch Surg. 1997;132(8):926-930. doi:10.1001/archsurg.1997.01430320128023

Objective:  To describe our experience in the management of patients with pancreatic insulinomas, emphasizing the need for preoperative localization and the outcome of surgical treatment.

Design:  A case series.

Setting:  A university hospital in Hong Kong.

Patients:  From 1981 to 1995, 27 patients with pancreatic insulinomas were surgically treated; the mean follow-up was 25.4 months.

Main Outcome Measures:  Postoperative morbidity and euglycemia during the follow-up period.

Results:  The accuracy of tumor localization by ultrasonography, computed tomography, and angiography was 33%, 44%, and 52%, respectively. Venous sampling for an insulin assay regionalized 90% of the tumors. In 24 patients with solitary tumors, most lesions detected or missed by preoperative localization could be either seen (n=14) or palpated (n=22). Intraoperative ultrasonography (n=17) has been routinely performed since 1987; nonpalpable tumors were imaged in 2 of 15 patients with solitary tumors. Eight solitary occult tumors were detected by palpation alone or a combination of palpation and intraoperative ultrasonography. Operative mortality occurred in 1 (3.7%) of the 27 patients, while major morbidity developed in 9 (33%) of the patients. Euglycemia was achieved in 25 patients. Surgery cured all patients with benign insulinomas, whereas the cure rate for patients with malignant neoplasms was only 33%. The type of surgical treatment or correct preoperative localization did not affect the outcome of surgery.

Conclusions:  Pancreatic insulinomas can be readily localized intraoperatively despite failed preoperative localization studies. Surgical treatment cured benign adenomas but was associated with notable morbidity.Arch Surg. 1997;132:926-930

Service FJ, McMahon MM, O'Brien PC, Ballard DJ.  Functioning insulinoma: incidence, recurrence, and long-term survival of patients: a 60-year study . Mayo Clin Proc . 1991;66:711-719.Article
Wilder RM, Allan FN, Power MH, Robertson HE.  Carcinoma of the islands of the pancreas: hyperinsulinism and hypoglycemia . JAMA . 1927;89:348-355.Article
Kung AWC, Chan FL, Tam SCF, Lam KSL.  Localization of occult insulinoma by intraarterial stimulation with calcium and venous sampling technique . Clin Radiol . 1992;46:55-56.Article
van Heerden JA, Edis AJ, Service FJ.  The surgical aspects of insulinomas . Ann Surg . 1979:189:677-682.Article
Bieligk S, Jaffe BM.  Islet cell tumors of the pancreas . Surg Clin North Am . 1995; 75:1025-1040.
Galbut DL, Markowitz AM.  Insulinoma: diagnosis, surgical management and longterm follow-up . Am J Surg . 1980;139:682-690.Article
Service FJ, Dale AJD, Elveback LR, Jiang NS.  Insulinoma: clinical and diagnostic features of 60 consecutive cases . Mayo Clin Proc . 1976;51:417-429.
Rothmund M.  Localization of endocrine pancreatic tumours . Br J Surg . 1994; 81:164-166.Article
Axelrod L.  Insulinoma: cost-effective care in patients with a rare disease . Ann Intern Med . 1995;123:311-312.Article
Fedorak IJ, Ko TC, Gordon D, et al.  Localization of islet cell tumors of the pancreas: a review of current techniques . Surgery . 1993;113:242-249.
Rösch T, Lightdale CJ, Botet JE, et al.  Localization of pancreatic endocrine tumors by endoscopic ultrasonography . N Engl J Med . 1992;326:1721-1726.Article
Lamberts SWJ, Chayvialle JA, Krenning EP.  The visualization of gastroenteropancreatic endocrine tumors . Metabolism . 1992;41 ( (suppl 2) ):111-115.Article
Menegaux F, Schmitt G, Mercadier M, Chigot J-P.  Pancreatic insulinomas . Am J Surg . 1992;165:243-248.Article
Rothmund M, Angelini L, Brunt M, et al.  Surgery for benign insulinoma: an international review . World J Surg . 1990;14:393-399.Article
Glickman MH, Hart MJ, White TT.  Insulinoma in Seattle: 39 cases in 30 years . Am J Surg . 1980;140:119-125.Article
Gorman B, Charboneau JW, James EM, et al. al.  Benign pancreatic insulinoma: preoperative and intraoperative sonographic localization . AJR Am J Roentgenol . 1986; 147:929-934.Article
Grant CS, van Heerden JA, Charboneau JW, James EM, Reading CC.  Insulinoma: the value of intraoperative ultrasonography . Arch Surg . 1988;123:843-847.Article
Doppman JL, Chang R, Fraker DL, et al.  Localization of insulinomas to the region of the pancreas by intraarterial stimulation with calcium . Ann Intern Med . 1995;123:269-273.Article
Böttger TC, Weber W, Beyer J, Junginger T.  Value of tumor localization in patients with insulinoma . World J Surg . 1990;14:107-114.Article
van Heerden JA, Grant CS, Czako PF, Service FJ, Charboneau JW.  Occult functioning insulinomas: which localizing studies are indicated? Surgery . 1992;112: 1010-1014.
Vinik Al, Delbridge L, Moattari R, Cho K, Thompson N.  Transhepatic portal vein catheterization for localization of insulinomas: a ten-year experience . Surgery . 1991;109:1-11.
Pasieka JL, McLeod MK, Thompson NW, Burney RE.  Surgical approach to insulinomas: assessing the need for preoperative localization . Arch Surg . 1992; 127:442-447.Article
Doherty GM, Doppman JL, Shawker TH, et al.  Results of a prospective strategy to diagnose, localize, and resect insulinomas . Surgery . 1991;110:989-997.
Proye C, Boissel P.  Preoperative imaging versus intraoperative localization of tumors in adult surgical patients with hyperinsulinemia: multicenter study of 338 patients . World J Surg . 1988;12:685-690.Article
Norton JA, Cromack DT, Shawker TH, et al.  Intraoperative ultrasonographic localization of islet cell tumors: a prospective comparison to palpation . Ann Surg . 1988;207:160-168.Article
van Heerden JA, Lo CY.  Pancreatic endocrine disease . In: Carter DC, Russell RGC, Pitt HA, Bismuth H, eds. Rob & Smith Operative Surgery . New York, NY: Chapman & Hall; 1996:624-632.
Demeure MJU, Klonoff DC, Karam JH, Duh Q-Y, Clark OH.  Insulinomas associated with multiple endocrine neoplasia type I: the need for a different surgical approach . Surgery . 1991;110:998-1005.
O'Riordain DS, O'Brien T, van Heerden JA, Service FJ, Grant CS.  Surgical management of insulinoma associated with multiple endocrine neoplasia type I . World J Surg . 1994;18:488-494.Article
Thompson NW, Lloyd RV, Nishiyama RH, et al.  MEN I pancreas: a histological and immunohistochemical study . World J Surg . 1984;8:561-574.Article