Surgical management of insulinomas in multiple endocrine neoplasia type 1.
OBJECTIVE
This study aimed to evaluate the accuracy of preoperative and intraoperative diagnostic tools and the surgical strategy to obtain cure in multiple endocrine neoplasia type 1 (MEN-1) patients affected with insulinoma.


METHODS
Eight MEN-1 patients (1992-2009) were operated on for hypoglycemic crisis. Preoperative tumor localization was carried out. Ultrasound and modification of the insulin/glucose (I/G) ratio were applied intraoperatively. Pancreatic lesions larger than 0.5 cm were removed by resection of the most affected pancreatic region and by enucleation of nodules in least affected regions.


RESULTS
Two pancreatoduodenectomies and 6 distal pancreatectomies were performed; enucleation of nodules was necessary in 6 patients. There was no postoperative mortality. At the histopathologic analysis, a mean of 6 macrotumors and of 15.5 microlesions were found. Intraoperative ultrasound proved a sensitivity of 87.5% for detecting pancreatic insulinoma. Decrease in the I/G ratio after resection predicted postoperative outcome in all patients. At a mean follow-up of 81.5 months, all patients were normoglycemic with no evidence of disease recurrence.


CONCLUSIONS
Multiple endocrine neoplasia type 1 insulinomas should be considered surgically curable. Pancreatic resection seems preferable to a less radical surgical approach in ensuring higher cure rates. Intraoperative ultrasound and I/G ratio are of value in the assessment of surgical decision and in the evaluation of the surgical cure.
Department of Clinical Physiopathology, Surgical Unit, Medical School, University of Florence, Florence, Italy.
Francesco
F
Giudici
Gabriella
G
Nesi
Maria Luisa
ML
Brandi
Francesco
F
Tonelli
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology; D007328:Insulin / Q000097:blood; D007340:Insulinoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D016343:Monitoring, Intraoperative; D018761:Multiple Endocrine Neoplasia Type 1 / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D016896:Treatment Outcome
D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin