title: [Diagnosis and surgical treatment of insulinoma--experiences in 40 cases].
abstract: OBJECTIVE
  Most insulinomas are solitary, benign and functional neuroendocrine pancreatic tumors which give rise to manifold symptoms. Their preoperative localization is often unclear, but the cure rate after their excision is very high. It was the aim of this study to analyse and evaluate our group of patients with regard to preoperative tumor localization and overall surgical results.
  
  
  METHODS
  Data were collected as part of prospective observations and retrospective evaluation of all patients treated for insulinoma between 1987 and 2003 at the department of visceral- thoracic- and vascular surgery at the Philipps University of Marburg. In all of them the diagnosis had been confirmed by a fasting test.
  
  
  RESULTS
  40 patients with an insulinoma (22 females, 18 males; average age 52 years [range 12-87 years]) had been operated. The sensitivity of preoperative localization was 65% for endoscopic ultrasound, 33% for ultrasound, 33% for computed tomography, 15% for magnetic resonance imaging and 0% for somatostatin-receptor scintigraphy. But all insulinomas were identified intraoperatively by pancreas dissection and ultrasound (IOUS). 38 patients were completely cured by excision of the tumor.
  
  
  CONCLUSIONS
  After positive biochemical and fasting tests and exclusion of diffuse abdominal metastases by transabdominal ultrasound, all patients should without further preoperative investigations undergo surgical excision of the insulinoma after bidigital palpation of the pancreas and IOUS. But if laparoscopic excision is planned, endoscopic ultrasound should be undertaken preoperatively.
authors.affiliation: Klinik für Visceral-, Thorax- und Gefässchirurgie, Philipps-Universität Marburg. fendrich@med.uni-marburg.de
authors.forename: V
authors.initials: V
authors.lastname: Fendrich
authors.forename: D K
authors.initials: DK
authors.lastname: Bartsch
authors.forename: P
authors.initials: P
authors.lastname: Langer
authors.forename: A
authors.initials: A
authors.lastname: Zielke
authors.forename: M
authors.initials: M
authors.lastname: Rothmund
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D019160:Endosonography / Q000592:standards; D005215:Fasting; D005260:Female; D006801:Humans; D007340:Insulinoma / Q000175:diagnosis* / Q000601:surgery*; D007430:Intraoperative Care; D008279:Magnetic Resonance Imaging / Q000592:standards; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D011877:Radionuclide Imaging / Q000592:standards; D017481:Receptors, Somatostatin; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000592:standards; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D017481:Receptors, Somatostatin