[Surgical treatment of insulinoma: study of 59 cases].
After establishing the diagnosis of an insulinoma the next step is its localization in order to perform the most suitable management approach.


OBJECTIVE
To evaluate the methods used for the diagnosis of insulinoma and the localization of its site as well as the results of the surgical treatment.


METHODS
Fifty nine consecutive patients with pancreatic insulinomas were studied. The discriminative power of the preoperative investigations in the localization of insulinomas was analysed. Special attention was focused to the intra operative methods of tumor localizations. The early and late results of the surgical treatment were also investigated.


RESULTS
There were 55 benign cases and 4 malignant tumors. Preoperative localization was attempted by using ultrasonography (positive in 28.1%) CT imaging (positive in 25%), selective arteriography (positive in 54.1%), endoscopic ultrasonography (positive in 27.2%) and assay of portal plasma insulin levels (positive in 94.4%). In 54/55 cases (98.2%) the tumors were identified intraoperatively by palpation. By addition of intraoperative ultrasonography all lesions were identified and successfully removed without mortality. Five patients had multiple endocrine neoplasias all with multiple lesions in the pancreas. In patients with benign lesions 29 enucleations and 32 resections were performed. Pancreatic fistulas were the most common complication (29/59). Excluding the patients with malignant lesions the recovery rate was 98.1%. Three patients who underwent corporo caudal pancreactectomy developed diabetes.


CONCLUSIONS
The preoperative localization is not necessary, since a combination of palpation and intraoperative ultrasonography can deal with most cases. Enucleation when possible is the best choice for benign lesions.
Disciplina de Cirurgia do Aparelho Digestivo, Faculdade de Medicina, Universidade de São Paulo.
M C
MC
Machado
J
J
Jukemura
J E
JE
da Cunha
S
S
Penteado
T
T
Bacchella
E E
EE
Abdo
A
A
Montagnini
P
P
Herman
M A
MA
Machado
H W
HW
Pinotti
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007340:Insulinoma / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome
D007328:Insulin