Diagnosis and Surgical Intervention for Insulinoma：A Single-Institution Study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Ang , GUO Qiang ,  HU Weiming

Department of Hepatobiliopancreatic Surgery， West China Hospital， Sichuan University， Chengdu 610041， Sichuan Province， China;

Corresponding author：

HU Weiming, Email: huweiming64@gmail.com

Keywords：

Insulinoma; Diagnosis; Operation

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To analysis the characteristics of clinical manifestation， diagnosis， and surgical strategy of patients with insulinoma and to summarize the experience in diagnosis and treatment of insulinoma.
Methods 　The medical records of 88 patients with a clinical and pathologic diagnosis of insulinoma in West China Hospital from Oct. 2003 to Jan. 2010 were reviewed and the basic informations and therapeutic data were collected.
Results 　Among the 88 patients， 63 cases （71.6%） were female and 12 cases were multiple endocrine neoplasia Type I （MEN-1） tumors. Eighty-eight patients’ age was （38.59±11.95） years old， body mass index was 27.78±5.86， and tumor diameter was（1.62±0.70） cm. Eighty-six point four percent of the patients had Whipple’ triad and 79.5% of the patients had a overnight fasting ratio of plasma insulin to glucose greater than 0.3. Diagnostic sensitivity of transabdominal ultrasonography， computed tomography scan， magnetic resonance imaging， and intraoperative ultrasonography were 30.8% （24/78）， 74.6% （53/71）， 82.5% （47/57）， and 100% （59/59）， respectively. Distal pancreatectomy （28 cases） and enucleation（64 cases） were performed in those patients， and pancreatic fistula rate were 14.3% （4/28） and 37.5% （24/64） respectively（P＞0.05）. The total duration of hospitalization and postoperative hospitalization time of patients that performed the distal pancreatectomy or enucleation were 28 d and 16 dvs. 29 d and 13 d， respectively （P＞0.05）.
Conclusions 　Clinical diagnosis of insulinoma can rely on Whipple’ triad and plasma insulin/glucose value of fasting for 15 hours. Modern imaging has a high sensitivity of localization to avoid blind pancreatic resection. Complete surgical resection is the treatment of choice and enucleation acts as safe as distal pancreatectomy .

Citation： LI Ang,GUO Qiang,HU Weiming. Diagnosis and Surgical Intervention for Insulinoma：A Single-Institution Study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(7): 782-786. doi: Copy

1.	Service FJ. Hypoglycemic disorders[J]. N Engl J Med， 1995， 332(17)：1144-1152.
2.	Service FJ. Diagnostic approach to adults with hypoglycemic disorders[J]. Endocrinol Metab Clin North Am， 1999， 28(3)：519-532.
3.	Hirshberg B， Livi A， Bartlett DL， et al. Forty-eight-hour fast：the diagnostic test for insulinoma[J]. J Clin Endocrinol Metab， 2000， 85(9)：3222-3226.
4.	Perry RR， Vinik AI. Clinical review 72：diagnosis and management of functioning islet cell tumors[J]. J Clin Endocrinol Metab，.
5.	Yeo CJ， Cameron JL， Sohn TA， et al. Six hundred fifty consecutivepancreaticoduodenectomies in the 1990s：pathology， complications， and outcomes[J]. Ann Surg， 1997， 226(3)：248-257.
6.	Delcore R， Friesen SR. Gastrointestinal neuroendocrine tumors[J]. J Am Coll Surg， 1994， 178(2)：187-211.
7.	Boukhman MP， Karam JH， Shaver J， et al. Insulinoma—expe-rience from 1950 to 1995[J]. West J Med， 1998， 169(2)：98-104.
8.	Service FJ， McMahon MM， O’Brien PC， et al. Functioning insu-linoma—incidence， recurrence， and long-term survival of pati-ents：a 60-year study[J]. Mayo Clin Proc， 1991， 66(7)：711-719.
9.	Nikfarjam M， Warshaw AL， Axelrod L， et al. Improved contemporary surgical management of insulinomas：a 25-year experience at the Massachusetts General Hospital [J]. Ann Surg， 2008， 247(1)：165-172.
10.	Ardengh JC， Rosenbaum P， Ganc AJ， et al. Role of EUS in the preoperative localization of insulinomas compared with spiral CT[J]. Gastrointestinal Endoscopy， 2000， 51(5)：552-555.
11.	Besim H， Korkmaz A， Hamamcy O， et al. Review of eight cases of insulinoma[J]. East Afr Med J， 2002， 79(7)：368-372.
12.	Fendrich V， Bartsch DK， Langer P， et al. Diagnosis and surgical treatment of insulinoma—experiences in 40 cases[J]. Dtsch Med Wochenschr， 2004， 129(17)：941-946.
13.	Kann PH， Rothmund M， Zielke A. Endoscopic ultrasound imagingof insulinomas：limitations and clinical relevance[J]. Exp Clin Endocrinol Diabetes， 2005， 113(8)：471-474.
14.	王磊，周亚男，张文良，等. 胰岛素瘤的定位诊断与治疗(附38例报告)[J]. 中国普外基础与临床杂志， 2007， 14(2)：214-215.
15.	向光明，刘续宝. 胰腺内分泌肿瘤的影像学诊断[J]. 中国普外基础与临床杂志， 2012， 19(10)：1055-1058.
16.	刘尚龙，张太平，赵玉沛. 胰腺内分泌肿瘤外科诊治现状及进展[J]. 中国普外基础与临床杂志， 2012， 19(10)：1059-1062.
17.	孙达欣，徐进，戴显伟. 胰腺内分泌肿瘤的诊治[J]. 中国普外基础与临床杂志， 2012， 19(10)：1052-1054.
18.	杨春明. 常见胰腺神经内分泌肿瘤的诊断和治疗 [J]. 中国普外基础与临床杂志， 2012， 19(10)：1029-1032.
19.	陈曦，周光文. 胰腺神经内分泌肿瘤诊治热点探讨 [J]. 中国普外基础与临床杂志， 2012， 19(10)：1033-1038.
20.	Proye C. Endocrine tumours of the pancreas：an update[J]. AustN Z J Surg， 1998， 68(2)：90-100.
21.	Rothmund M， Angelini L， Brunt LM， et al. Surgery for benign insulinoma：an international review[J]. World J Surg， 1990， 14(3)：393-399.
22.	Lo CY， Lam KY， Kung AW， et al. Pancreatic insulinomas. A 15-year experience[J]. Arch Surg， 1997， 132(8)：926-930.
23.	Goh BK， Ooi LL， Cheow PC， et al. Accurate preoperative locali-zation of insulinomas avoids the need for blind resection and reop-eration：analysis of a single institution experience with 17 surgicallytreated tumors over 19 years[J]. J Gastrointest Surg， 2009， 13(6)：1071-1077.
24.	Gagner M， Pomp A. Laparoscopic pancreatic resection：is it wort-hwhile?[J]. J Gastrointest Surg， 1997， 1(1)：20-26.
25.	Roland CL， Lo CY， Miller BS， et al. Surgical approach and perioperative complications determine short-term outcomes in patients with insulinoma：results of a bi-institutional study[J]. Ann Surg Oncol， 2008， 15(12)：3532-3537.
26.	， 80(8)：2273-2278.

1. Service FJ. Hypoglycemic disorders[J]. N Engl J Med， 1995， 332(17)：1144-1152.
2. Service FJ. Diagnostic approach to adults with hypoglycemic disorders[J]. Endocrinol Metab Clin North Am， 1999， 28(3)：519-532.
3. Hirshberg B， Livi A， Bartlett DL， et al. Forty-eight-hour fast：the diagnostic test for insulinoma[J]. J Clin Endocrinol Metab， 2000， 85(9)：3222-3226.
4. Perry RR， Vinik AI. Clinical review 72：diagnosis and management of functioning islet cell tumors[J]. J Clin Endocrinol Metab，.
5. Yeo CJ， Cameron JL， Sohn TA， et al. Six hundred fifty consecutivepancreaticoduodenectomies in the 1990s：pathology， complications， and outcomes[J]. Ann Surg， 1997， 226(3)：248-257.
6. Delcore R， Friesen SR. Gastrointestinal neuroendocrine tumors[J]. J Am Coll Surg， 1994， 178(2)：187-211.
7. Boukhman MP， Karam JH， Shaver J， et al. Insulinoma—expe-rience from 1950 to 1995[J]. West J Med， 1998， 169(2)：98-104.
8. Service FJ， McMahon MM， O’Brien PC， et al. Functioning insu-linoma—incidence， recurrence， and long-term survival of pati-ents：a 60-year study[J]. Mayo Clin Proc， 1991， 66(7)：711-719.
9. Nikfarjam M， Warshaw AL， Axelrod L， et al. Improved contemporary surgical management of insulinomas：a 25-year experience at the Massachusetts General Hospital [J]. Ann Surg， 2008， 247(1)：165-172.
10. Ardengh JC， Rosenbaum P， Ganc AJ， et al. Role of EUS in the preoperative localization of insulinomas compared with spiral CT[J]. Gastrointestinal Endoscopy， 2000， 51(5)：552-555.
11. Besim H， Korkmaz A， Hamamcy O， et al. Review of eight cases of insulinoma[J]. East Afr Med J， 2002， 79(7)：368-372.
12. Fendrich V， Bartsch DK， Langer P， et al. Diagnosis and surgical treatment of insulinoma—experiences in 40 cases[J]. Dtsch Med Wochenschr， 2004， 129(17)：941-946.
13. Kann PH， Rothmund M， Zielke A. Endoscopic ultrasound imagingof insulinomas：limitations and clinical relevance[J]. Exp Clin Endocrinol Diabetes， 2005， 113(8)：471-474.
14. 王磊，周亚男，张文良，等. 胰岛素瘤的定位诊断与治疗(附38例报告)[J]. 中国普外基础与临床杂志， 2007， 14(2)：214-215.
15. 向光明，刘续宝. 胰腺内分泌肿瘤的影像学诊断[J]. 中国普外基础与临床杂志， 2012， 19(10)：1055-1058.
16. 刘尚龙，张太平，赵玉沛. 胰腺内分泌肿瘤外科诊治现状及进展[J]. 中国普外基础与临床杂志， 2012， 19(10)：1059-1062.
17. 孙达欣，徐进，戴显伟. 胰腺内分泌肿瘤的诊治[J]. 中国普外基础与临床杂志， 2012， 19(10)：1052-1054.
18. 杨春明. 常见胰腺神经内分泌肿瘤的诊断和治疗 [J]. 中国普外基础与临床杂志， 2012， 19(10)：1029-1032.
19. 陈曦，周光文. 胰腺神经内分泌肿瘤诊治热点探讨 [J]. 中国普外基础与临床杂志， 2012， 19(10)：1033-1038.
20. Proye C. Endocrine tumours of the pancreas：an update[J]. AustN Z J Surg， 1998， 68(2)：90-100.
21. Rothmund M， Angelini L， Brunt LM， et al. Surgery for benign insulinoma：an international review[J]. World J Surg， 1990， 14(3)：393-399.
22. Lo CY， Lam KY， Kung AW， et al. Pancreatic insulinomas. A 15-year experience[J]. Arch Surg， 1997， 132(8)：926-930.
23. Goh BK， Ooi LL， Cheow PC， et al. Accurate preoperative locali-zation of insulinomas avoids the need for blind resection and reop-eration：analysis of a single institution experience with 17 surgicallytreated tumors over 19 years[J]. J Gastrointest Surg， 2009， 13(6)：1071-1077.
24. Gagner M， Pomp A. Laparoscopic pancreatic resection：is it wort-hwhile?[J]. J Gastrointest Surg， 1997， 1(1)：20-26.
25. Roland CL， Lo CY， Miller BS， et al. Surgical approach and perioperative complications determine short-term outcomes in patients with insulinoma：results of a bi-institutional study[J]. Ann Surg Oncol， 2008， 15(12)：3532-3537.
26. ， 80(8)：2273-2278.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and Surgical Intervention for Insulinoma：A Single-Institution Study

Abstract Full text Figures/Tables Video References Cited by

Format

Content