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Pancreatic Insulinomas A 15-Year Experience

Chung-Yau Lo, FRCS(Edin); King-Yin Lam, FRCPA; Annie W. C. Kung, MD, FRCP(Edin); Karen S. L. Lam, MD, FRCP, FRACP; Peter H. M. Tung, FRCS(Edin); Sheung-Tat Fan, MS, FRCS(Glasg)
Arch Surg. 1997;132(8):926-930. doi:10.1001/archsurg.1997.01430320128023.
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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


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