Diagnostik und operative Therapie beim Insulinom - Erfahrungen bei 40 Patienten

Fendrich, Volker; Bartsch, Detlef K.; Langer, P.; Zielke, A.; Rothmund, M.

doi:10.1055/s-2004-823060

Cited by 36 publications

(8 citation statements)

References 14 publications

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“…MEN1 insulinoma is usually diagnosed between the second and third decade of life; in the present study the median age at diagnosis was 27 years. This is about one decade earlier than sporadic insulinoma [38,39] and MEN1-ZES [40,41]. According to previous reports [1,4,6,17,18,20,22], insulinoma is the first manifestation of MEN1 in about 10% of patients, which is in line with the 8% rate in the present series.…”

Section: Discussionsupporting

confidence: 90%

Enucleation and Limited Pancreatic Resection Provide Long-Term Cure for Insulinoma in Multiple Endocrine Neoplasia Type 1

Bartsch¹,

Albers²,

Knoop³

et al. 2013

Neuroendocrinology

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Aim: To assess the characteristics and long-term outcome after surgery in patients with multiple endocrine neoplasia type 1 (MEN1)-associated insulinoma. Methods: Retrospective analysis of prospectively collected data of MEN1 patients with organic hyperinsulinism at a tertiary referral center. Results: Thirteen(17%) of74 patients with MEN1 had organic hyperinsulinism. The median age at diagnosis was 27 (range 9-48) years. In 7 patients insulinoma was the first manifestation of the syndrome. All patients had at least one pancreatic neuroendocrine neoplasm (pNEN) upon imaging, including CT, MRI or endoscopic ultrasonography. Seven patients had solitary lesions upon imaging, 4 patients had one dominant tumor with coexisting multiple small pNENs, and 2 patients had multiple lesions without dominance. Eight patients had limited resections (1 segmental resection, 7 enucleations), 4 subtotal distal pancreatectomies, and 1 patient a partial duodenopancreatectomy. There was no postoperative mortality. Six patients experienced complications, including pancreatic fistula in 5 patients. Pathological examination revealed median three (range 1-14) macro-pNENs sized between 6 and 40 mm, and a total of 14 potentially benign insulinomas were detected in the 13 patients. After median follow-up of 156 months, only 1 patient developed recurrent hyperinsulinism after initial enucleation. Twelve patients developed new pNENs in the pancreatic remnant and 4 patients underwent reoperations (3 for metastatic ZES, 1 for recurrent hyperinsulinism). One of 5 patients with an initial extended pancreatic resection developed insulin-dependent diabetes mellitus. Conclusion: Enucleation and limited resection provide long-term cure forMEN1 insulinoma in patients with solitary or dominant tumors. Subtotal distal pancreatectomy should thus be preserved for patients with multiple pNENs without dominance given the risk of exocrine and endocrine pancreas insufficiency in the mostly young patients.

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Section: Discussionsupporting

confidence: 90%

Enucleation and Limited Pancreatic Resection Provide Long-Term Cure for Insulinoma in Multiple Endocrine Neoplasia Type 1

Bartsch¹,

Albers²,

Knoop³

et al. 2013

Neuroendocrinology

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“…The average sensitivity of transabdominal ultrasonography ranges from 9.6% to 33%. [678] It is an economical, convenient, and noninvasive diagnostic modality and, therefore, still used as a routine method for clinical examination. Although contrast-enhanced ultrasonography with SF 6 is reported to have a much higher sensitivity (92.31%) than the conventional technique,[9] it is not widely used.…”

Section: Preoperative Localization Methodsmentioning

confidence: 99%

“…Enhanced computer tomography (CT) has a relatively high sensitivity (33%–60%) for the diagnosis of insulinomas. [67810] Although CT imaging findings can help exclude metastatic diseases, tumors <1 cm are not easily detected by CT. Arteriography performed in conjunction with CT can detect lesions as small as 1.0 cm × 0.8 cm. [11] Recent advances in CT equipment have enabled the detection of insulinomas with greater efficacy.…”

Section: Preoperative Localization Methodsmentioning

confidence: 99%

“…The sensitivity of EUS for the detection of insulinomas ranges from 65% to 100%. [67810] Téllez-Ávila et al . reported in a study on the comparison of the efficacies of CT and EUS in the detection of insulinomas that the sensitivity and accuracy of EUS were 100% and 95.4%, while those of CT were 60% and 68%, respectively.…”

Section: Preoperative Localization Methodsmentioning

confidence: 99%

“…The sensitivity of palpation in conjunction with intraoperative ultrasonography for the detection of insulinomas can be as high as 100%. [7816171819] However, open surgery is a traumatic procedure and requires a large incision, which cannot satisfy the growing expectations of minimally invasive management of small-sized tumors.…”

Section: Surgical Management Of Insulinomamentioning

confidence: 99%

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Efficacy of laparoscopic ultrasonography in laparoscopic resection of insulinoma

Wang

Zhang

et al. 2017

Endosc Ultrasound

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Insulinoma is the most common functioning islet cell tumor of the pancreas, with an annual incidence of 4 cases/1 million individuals. It is treated by surgical methods. Open surgery was once considered the standard approach for the treatment of insulinoma. However, the procedure is traumatic and requires a large incision, which does not satisfy the growing expectations of minimally invasive management of small-sized tumors. Insulinomas are usually benign solitary tumors and mostly occur sporadically, which makes them suitable candidates for laparoscopic management. The potential advantages of laparoscopic management of insulinoma over open surgery include shorter duration of hospitalization, quicker recovery, and better cosmetic effect. However, because of the small tumor size as well as the depth and uncertainty of the location of the tumor, laparoscopic localization of the lesion without tactile sensation is difficult. Laparoscopic ultrasonography can detect about 90% of insulinomas, and its sensitivity is comparable to that of manual palpation along with intraoperative ultrasonography during open surgery; thus, it ensures the feasibility of laparoscopic management of insulinoma and reinforces its advantage as a minimally invasive procedure. Laparoscopic ultrasonography is vital for the localization of insulinomas and characterization of the surrounding pancreatic structure and should, therefore, be considered an integral part of the laparoscopic management of insulinoma.

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Importance of localization of insulinomas: a systematic analysis

Burghardt

Meier

Uhl

et al. 2019

J Hepato Biliary Pancreat

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BackgroundProcedures suitable for preoperative localization of insulinomas are widely used but it is unclear whether they determine surgical success. We wanted to clarify whether preoperative localization or intraoperative ultrasound determines the success of surgically identifying and removing insulinomas.MethodsWe performed a systematic literature search (PubMed) yielding 100 publications with patient‐level data on preoperative localization procedures, intraoperative ultrasound, success of surgical identification and removal or single, benign insulinomas (published until 31 December 2016). The consequences of successful preoperative localization and intraoperative ultrasound for surgical identification and removal of an insulinoma could be analyzed for 863 and 529 patients with single benign insulinomas, respectively. Sensitivities of commonly employed methods to localize biochemically proven insulinomas were calculated for single benign (1,153 patients), multiple benign, and malignant insulinomas, also in relation to diameter and intra‐pancreatic location.ResultsThe success of surgery (identification and removal of single benign insulinomas) in patients with a biochemically proven insulinoma was high (approximately 98%) even in the absence of preoperative localization. However, successful preoperative localization or intraoperative ultrasonography slightly, but significantly, increased the probability of surgically identifying/removing single benign insulinomas (by 1.4% and 2.0%, P = 0.012 and 0.0032, respectively). Diagnostic sensitivities of localization procedures varied widely, with GLP‐1 receptor scintigraphy achieving the highest sensitivity despite its non‐invasive nature.ConclusionThe probability of surgically identifying and removing a single, benign insulinoma is high even in the absence of successful preoperative localization or intraoperative ultrasound. However, both approaches slightly, but significantly, improve the outcome to near 100%.

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Diagnostik und operative Therapie beim Insulinom - Erfahrungen bei 40 Patienten

Cited by 36 publications

References 14 publications

Enucleation and Limited Pancreatic Resection Provide Long-Term Cure for Insulinoma in Multiple Endocrine Neoplasia Type 1

Enucleation and Limited Pancreatic Resection Provide Long-Term Cure for Insulinoma in Multiple Endocrine Neoplasia Type 1

Efficacy of laparoscopic ultrasonography in laparoscopic resection of insulinoma

Importance of localization of insulinomas: a systematic analysis

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