Laparoscopically treated pancreatic insulinoma (original) (raw)

Laparoscopically treated pancreatic insulinoma. Case report

Journal of medicine and life

Usually, insulinomas are small sized, insulin secreting, benign tumors of the pancreas, and require surgical treatment. We report the case of a female patient, of 61 years old, with pancreatic insulinoma localized in the junction between the head and the istm of the pancreas, of 1,4 cm in size, which induced hypoglycemia due to endogenous insulin hypersecretion. The tumor was removed by laparoscopic enucleation in March 2009. In the postoperative period, the blood glucose level came back to normal.

Surgical treatment of pancreatic insulinomas in the era of laparoscopy

Surgical Endoscopy, 2004

Background: Laparoscopic resection has been increasingly reported for pancreatic insulinomas. This report evaluates our experience with surgical treatment for pancreatic insulinomas in this era of laparoscopy and reviews the application, safety, and outcome of this surgical approach reported in the literature. Methods: In a consecutive series of 10 patients with pancreatic insulinomas, laparoscopic resection was performed for selected patients after routine preoperative localizations. The outcome of this operative strategy was reviewed together with reported cases involving laparoscopic resection of pancreatic insulinomas. Results: Laparoscopic distal pancreatectomy or enucleation was performed for four patients with tumors located at the body or tail of the pancreas, whereas open enucleation was performed for six patients with tumors located at the pancreatic head. Pancreatic leak developed in one laparoscopic and two open enucleations. A review of reported cases in the literature showed that 61 of 69 attempted laparoscopic pancreatic resections for insulinomas were performed successfully. All except two tumors were located at the body or tail of the pancreas. For 42 cases with detailed information, 41 tumors at the pancreas body or tail were removed successfully by enucleation (n = 24) or distal pancreatic resection (n = 17), and one tumor at the pancreatic head was enucleated successfully. Pancreatic fistula, the most frequent complication, occurred in 8 (19%) of 42 laparoscopic resections. Conclusions: Laparoscopic resection of pancreatic insulinomas is safe and feasible for tumors located at the body or tail of the pancreas. Its application for tumors located at the pancreatic head needs further evaluation.

Laparoscopic Surgery for Pancreatic Insulinomas: A Single-Institution Experience of 29 Cases

Journal of Gastrointestinal Surgery, 2009

Background Laparoscopic approach has been increasingly used in the treatment of pancreatic benign diseases. This report evaluates our experience with laparoscopic surgery for pancreatic insulinomas. Methods Between July 2000 and December 2007, laparoscopic pancreatectomy was attempted in 29 consecutive patients with insulinomas. The localization of tumors, operating characteristics, and clinical outcomes were analyzed. Results Tumors were precisely localized in 28 of 29 (96.6%) patients by a combination of preoperative imaging techniques and intraoperative ultrasonography. Laparoscopic pancreatectomy was successfully performed in 26 patients, including enucleation (n=14), hand-assisted enucleation (n=2), and distal pancreatectomy with (n=9) or without (n=1) spleen preservation. Two conversions to open procedure were required because of unfavorable locations of the tumors. The pancreatic fistula occurred in four patients who underwent tumor enucleation. The median hospital stay was 5.5 days (range, 3-18 days) after laparoscopic procedure. Twenty-eight patients with pancreatic resection were free of symptoms and remained normoglycemic after a median follow-up period of 19 months (range, 10-36 months). Conclusion Laparoscopic pancreatic resection is a feasible and safe procedure for patients with insulinomas. Further studies are required to evaluate the potential application of the hand-assisted approach for tumors located at anatomically unfavorable positions.

Surgical Treatment of Pancreatic Insulinomas: A Series of 15 Years

Journal of Cancer Research Reviews & Reports, 2021

Insulinomas, although rare, are the most common pancreatic functioning neuroendocrine tumors. The diagnostic workup is commonly made late in time and surgical treatment is the only curative method. Our aim was to analyze the surgical approach to pancreatic insulinomas, through a 15-year series of patients who underwent surgery for this matter. From January 2006 to December 2020, we performed a retrospective review of the medical records of all the patients who underwent surgical treatment for insulinoma. Fourteen patients with insulinoma performed surgical intervention, 78,6% were of the female gender and the mean age was 48 years (19-86 years). Four (28,6%) of the tumors were located in the head of the pancreas, 5 (35,7%) in the body and 5 (35,7%) in the tail. Complications occurred in 4 patients (28,6%) following surgery. On follow-up, there was one (7,1%) case of local recurrence, thus necessitating a new surgical intervention [1-8].

Insulinoma of Pancreas, Brief Experience at a Dedicated Surgical Oncology Department

Computers & Operations Research, 2020

Introduction: Insulinoma of pancreas is a rare neuroendocrine tumor (NET). Mostly insulinomas are benign and solitary. They can have association with multiple endocrine neoplasia 1 (MEN -1). Insulinomas presents with symptoms of hypoglycemia. Most of the times the symptoms are vague and result in delay in the diagnosis and hence management. After appropriate diagnostic and localization investigations along with metastatic workup, surgery is the treatment of choice. Surgery can offer cure. Minimally invasive surgery can offer potential benefits of minimal morbidity and at least equal oncological outcomes. Study Design: Case series. Place and Duration of Study: Department of Surgical Oncology, Shaukat Khanam Memorial Cancer Hospital & Research Center (SKMCH&RC), from January 2011 to March 2020. Methodology: We studied a total of five patients that presented to SKMCH&RC in the above-mentioned period. Detailed clinical information of these five patients, including sociodemographic varia...

Laparoscopic surgery for pancreatic insulinomas: an update

HORMONES, 2016

Insulinomas are the most common functioning neuroendocrine tumors of the pancreas, occurring in almost 1-4 per 1 million persons each year. In contrast to other pancreatic neuroendocrine tumors, they are usually benign and solitary at the time of diagnosis. Due to their benign nature, surgical excision is the treatment of choice, with excellent long-term results. The introduction of minimally invasive techniques in the surgical treatment of insulinoma has been gaining popularity due to shorter length of hospital stay and better cosmetic results, with serious complications being comparable to those of open surgery. Preoperative localization is of paramount importance in the determination of the appropriate surgical approach. Many invasive and non-invasive methods exist for localization of an insulinoma. A combination of these modalities is usually adequate to preoperatively localize the vast majority of tumors. Laparoscopic ultrasound is mandatory to localize these tumors intraoperatively. Despite extensive experience in highly specialized centers producing encouraging results, no randomized trials have been realized to conclusively validate these case series, this partly due to the rarity of insulinoma in the population. In this article we present the current state of laparoscopic management of insulinoma delineating still unanswered issues and we underscore some of the technical details of the most common laparoscopic procedures employed.

Laparoscopic Distal Pancreatectomy for Insulinoma

Journal of Gastroenterology & Digestive Systems, 2019

Insulinomas are benign neuroendocrine tumors which are the most common of the pancreatic islet cell tumors, yet they remain a rarity. The incidence is 1-4 cases in one million patients a year. 60% are woman with a median age at presentation of 47 years. 90% are solitary and 10% multiple. More than 90% are benign adenomas and about 5%-6% of cases are malignant, and 5%-8% are associated with multiple endocrine neoplasms (MEN type I). Most insulinoma are 1-3 cm in size. Hyperinsulinism causes severe hypoglycemia and leads convulsion, depression and coma. Initial operation is curative in 88%, and long-term survival is normal. Recurrence rates of 7% (sporadic) and 21% (MEN type I) have been reported at 20 years. Clinical manifestation related with endogenous hyperinsulinism: autonomic (less specific) like sweat, worried, tremble, nausea, hungry palpitation and tingling. The more specific neuroglycopenic are confusion, changes of behavior, dizzy, headache, and weakness. The classic diagno...

Insulinoma located in the head of the pancreas: Is there an alternative to surgery?

International Journal of Case Reports and Images, 2014

Introduction: Insulinoma is a gastrointestinal tumor, usually benign, which derived from pancreatic beta cells and typically induced by endogenous hyperinsulinism with an incidence rate of 1-4 cases per million inhabitants each year. this case report describes the diagnostic challenges and dilemmas associated with finding optimal treatment for an insulinoma located in the head of the pancreas. case report: A 41-yearold female was presented with recurrent, nagging headaches, loss of attention and episodes of anxiety accompanied by a feeling of 'heart palpitation'. based on the test results, reactive hypoglycemia was diagnosed and further symptomatic treatment was recommended. the patient was admitted again nine years after her initial hospitalization for symptoms of hypoglycemia. Abnormally, high insulin and peptide c secretion was found. computed tomography (ct) scan revealed a tumor with a size of 1.8x1.3x2.2 cm located within the uncinate

Pancreatic Insulinoma: A Surgical Experience

World Journal of Surgery, 2009

Background Small size, high benignity rate, and sporadic nature make insulinomas suitable for laparoscopic resection. On the other hand, occult location or multicentricity mandate open surgery. This study was designed to analyze a series of patients who had pancreatic insulinomas and underwent initial treatment at our institution. Methods Clinical records of the 34 patients with pancreatic insulinomas who underwent surgical resection between 1995 and 2007 were reviewed. Main variables for analysis were cure of the disease and surgical complications. Results There were 20 women and 14 men with a mean age of 40 ± 13 years. Mean size of the tumors was 2.2 ± 1 cm. Laparoscopic resection was completed in 14 of 21 patients. Most tumors that were resected by laparoscopy were solitary, benign, and located in the body and tail of the pancreas. Open surgery was selected for 13 patients, including 7 sporadic (5 in the head), 4 related to the MEN syndrome, and 2 malignant tumors. Surgical morbidity occurred in 23 patients. The most common complication was pancreatic fistula (3/13 in open, 4/14 in laparoscopic, and 6/7 in conversions). One patient in the open group died 15 days after surgery from massive PTE. Postoperative normoglycemia was achieved in all patients and persisted for a follow-up period of 4 ± 3.7 years. Conclusions Most insulinomas in our series were small and benign. Tumors that were located in the body and tail were more often amenable for laparoscopic resection. The cure rate was very high. Pancreatic fistula was the most frequent complication.