The importance of preoperative localisation procedures in organic hyperinsulinism--experience in 67 patients.
BACKGROUND
Preoperative localisation of insulinomas has been regarded unnecessary, given the significantly higher detection rates of intraoperative ultrasonography and bidigital palpation. These are mandatory before endoscopic surgery.


METHODS
67 patients operated on for organic hyperinsulinism were retrospectively analysed regarding tumour localisation within the pancreas, tumour size, histological findings, sensitivities of preoperative imaging methods, and surgical techniques.


RESULTS
59 patients (88%) had solitary insulinomas, four patients (6%) multiple insulinomas and four adult patients (6%) nesidioblastosis. Well-differentiated neuroendocrine tumours with benign behaviour (including four patients with nesidioblastosis) were diagnosed in 53 patients (79%), tumours with uncertain behaviour in nine patients (13%) and well-differentiated neuroendocrine carcinomas in five (8%). Tumours were evenly distributed throughout the pancreas. Endoscopic ultrasound localised tumours in 15 out of 21 patients (71%), conventional computed tomography (CT) in 7 out of 21 (33%), single-slice helical CT in 7 out of 12 (58%), multidetector CT in 5 out of 5 (100%), magnetic resonance imaging in 11 out of 13 (85%) and angiography in 15 out of 23 (65%). Various combinations of available methods achieved a sensitivity of 88% (49 patients true positive, 4 true negative, 7 false negative). Of 59 patients, solitary insulinomas were enucleated in 47 (80%), 11 patients underwent conventional open resection and one patient endoscopic distal pancreatic resection. Patients with nesidioblastosis or multiple tumours underwent pancreatic resections alone or in combination with enucleations.


CONCLUSIONS
After biochemical diagnosis of organic hyperinsulinism, preoperative localisation is necessary for planning endoscopic pancreatic surgery, because of the possibility of multiple insulinomas, malignancy or nesidioblastosis in adults.
Section Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria. Klaus.Kaczirek@meduniwien.ac.at
Klaus
K
Kaczirek
Ahmed
A
Ba-Ssalamah
Wolfgang
W
Schima
Bruno
B
Niederle
D018278:Carcinoma, Neuroendocrine / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D007340:Insulinoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome