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129. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

24.04. - 27.04.2012, Berlin

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A systematic review in the surgical treatment of Insulinoma

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  • Mohammadreza Hafezi - Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
  • Lars Fischer - Uniklinik Heidelberg Chirurgische Klinik, Viszeralchirurgie, Heidelberg
  • Hamidreza Fonouni - Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
  • Mohammad Golriz - Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
  • Camelia Garoussi - Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
  • Koosha Ghazi-Moghadam - Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
  • Markus Wolfgang Büchler - Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg
  • Arianeb Mehrabi - Chirurgische Univ.-Klinik Heidelberg, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Heidelberg

Deutsche Gesellschaft für Chirurgie. 129. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 24.-27.04.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12dgch305

doi: 10.3205/12dgch305, urn:nbn:de:0183-12dgch3059

Published: April 23, 2012

© 2012 Hafezi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Introduction: Insulinoma is a rare pancreatic tumor. Surgery is the treatment of choice for insulinoma. An exact localization is necessary to plan the appropriate surgical approach to prevent Diabetes mellitus.

Materials and methods: In this survey, 6236 cases were reviewed and different aspects of insulinoma were considered with emphasis on localization techniques and surgical treatment. The metastasis, morbidity and mortality rate were extracted.

Results: Insulinoma happen mostly (71.1 %) in fifth decade of life. Male to female ratio was 1:1.4. They occurred mostly sporadic (94 %) and sometimes in association with MEN-1 (6 %). 87.1 % of tumors were benign and 90.4 % of the tumors were single. The tumors were less than 20 mm in 83.6 %. They distributed in head and neck (43 %), tail (31 %) and body (25 %). Pre-operative non-invasive modalities sonography, CT-scan and MRI, were applied in 34.4, 37.3 and 9.5 % of patients, respectively. They succeeded in 32.6, 43.9 and 53.3 %, respectively. CT-scan is routinely used as first choice. Intra-operative palpation and sonography (IOUS), were applied in 25 and 19.9 % of evaluated patients and were successful in 81.4 and 91.2 %. IOUS is usually performed as the most reliable technique in exact localizing insulinomas and determines the surgical procedure.

Conclusion: Enucleation is the most type of surgery (55.9 %) due to the tendency of pancreas preserving surgery. Resection is applied in multiple, malignant, large tumors and for closed tumors to the ducts. Almost 56 % of metastases involve liver and lymph nodes. Despite the development of laparoscopic surgery in recent years, the open approach is still the favourite surgical method, which was applied in 90.1 % of cases. The most common surgical complication was fistula (14.2 % in open and 7.2 % in laparoscopy approach). In spite of high cure rate, recurrence occurs in 9.3 % of surgeries and the mortality rate is 5.2 %.