title: Preoperative localisation and surgical management of insulinoma: single centre experience.
abstract: BACKGROUND
  The majority of insulinomas are benign, small and intrapancreatic. Preoperative localisation is important to plan the surgical management.
  
  
  METHODS
  We retrospectively analysed our data on the preoperative imaging, type of surgery and histopathological features of the operated patients with an insulinoma from January 1993 to March 2010. Univariate and multivariate analyses were performed to detect the predictive factors for survival following surgery.
  
  
  RESULTS
  Forty patients were operated on for insulinoma, of which 33 were benign and 7 were malignant. The sensitivity of preoperative computed tomogram scan, magnetic resonance imaging and endoscopic ultrasound, for localising the lesions was 62, 82 and 94%, respectively. Enucleation was performed in 21 (52.5%) patients, and remaining had pancreatic resection. Hepatic resection was performed in 2 and liver transplantation in 1 patient. Morbidity and perioperative mortality was 17 (42.5%) and 1 (2.7%), respectively. The overall 5- and 10-year survival was 89 and 86.5%, respectively. The presence of metastases was found to be an independent predictor of poor survival on multivariate analysis.
  
  
  CONCLUSIONS
  Preoperative computed tomogram/magnetic resonance imaging and endoscopic ultrasound are sensitive in localizing the majority of insulinomas. Surgery offers a good long-term survival, even in patients with malignant insulinoma.
authors.affiliation: The Liver Unit, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, UK.
authors.forename: Vibha
authors.initials: V
authors.lastname: Varma
authors.forename: Laura
authors.initials: L
authors.lastname: Tariciotti
authors.forename: Christopher
authors.initials: C
authors.lastname: Coldham
authors.forename: Phillipe
authors.initials: P
authors.lastname: Taniere
authors.forename: John A
authors.initials: JA
authors.lastname: Buckels
authors.forename: Simon R
authors.initials: SR
authors.lastname: Bramhall
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D019160:Endosonography; D005260:Female; D006801:Humans; D007340:Insulinoma / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D007902:Length of Stay; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D010185:Pancreatic Fistula / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D055815:Young Adult