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Langenbeck's Archives of Surgery
Published in: Langenbeck's Archives of Surgery 7/2016

01-11-2016 | ORIGINAL ARTICLE

Diagnosis and surgical management of insulinomas in 33 consecutive patients at a single institution

Authors: Jishu Wei, Xinchun Liu, Junli Wu, Wenbin Xu, Wentao Gao, Kuirong Jiang, Zhihong Zhang, Yi Miao

Published in: Langenbeck's Archives of Surgery | Issue 7/2016

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Abstract

Purpose

The purpose of this study was to evaluate the diagnosis and surgical management of insulinomas in a single-center setting.

Methods

Demographic details, clinical presentation, preoperative diagnosis, surgical strategy, and outcomes of 33 consecutive patients who underwent surgery for insulinoma were analyzed retrospectively.

Results

The median time from the first onset of symptoms to diagnosis was 24 months (range 3 days to 50 years). All cases presented with Whipple’s triad and had a fasting insulin to glucose ratio higher than 0.33. The preoperative detection rates of transabdominal ultrasonography, CT, MRI, and EUS were 22 % (2/9), 72 % (23/32), 75 % (9/12), and 80 % (4/5), respectively. Intraoperative manual palpation localized all cases. Enucleation was performed in 58 % of cases (19/33), partial pancreatic resection in 39 % (13/33), and enucleation plus partial resection in 3 % (1/33). Pancreatic fistula was the most common complication and occurred in 15 patients (45 %), including seven grade A, five grade B, and three grade C fistulas. There was no mortality. When compared with partial pancreatectomy, enucleation held a significant advantage in operative time and operative bleeding, with no significant differences in demographic data and postoperative complications. During a median follow-up period of 32 months, two patients were lost to follow-up and the remaining 31 patients were without evidence of recurrence.

Conclusions

A fasting insulin release index larger than 0.3 is a reliable indicator for the diagnosis of insulinoma. Intraoperative palpation by an experienced surgeon can effectively complement an uncertain preoperative localization. Compared with partial pancreatic resection, enucleation showed significant benefit in terms of intraoperative blood loss and operation time.
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Metadata
Title
Diagnosis and surgical management of insulinomas in 33 consecutive patients at a single institution
Authors
Jishu Wei
Xinchun Liu
Junli Wu
Wenbin Xu
Wentao Gao
Kuirong Jiang
Zhihong Zhang
Yi Miao
Publication date
01-11-2016
Publisher
Springer Berlin Heidelberg
Published in
Langenbeck's Archives of Surgery / Issue 7/2016
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-016-1496-y

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