title: The surgical management of insulinomas in children.
abstract: OBJECTIVE
  Insulinomas are rare pediatric tumors for which optimal localization studies and management remain undetermined. We present our experience with surgical management of insulinomas during childhood.
  
  
  METHODS
  A retrospective review was performed of patients who underwent surgical management for an insulinoma from 1999 to 2012.
  
  
  RESULTS
  The study included eight patients. Preoperative localization was successful with abdominal ultrasound, abdominal CT, endoscopic ultrasound, or MRI in only 20%, 28.6%, 40%, and 50% of patients, respectively. Octreotide scan was non-diagnostic in 4 patients. For diagnostic failure, selective utilization of 18-Fluoro-DOPA PET/CT scanning, arterial stimulation/venous sampling, or transhepatic portal venous sampling were successful in insulinoma localization. Intraoperatively, all lesions were identified by palpation or with the assistance of intraoperative ultrasound. Surgical resection using pancreas sparing techniques (enucleation or distal pancreatectomy) resulted in a cure in all patients. Postoperative complications included a pancreatic fistula in two patients and an additional missed insulinoma in a patient with MEN-1 requiring successful reoperation.
  
  
  CONCLUSIONS
  Preoperative tumor localization may require many imaging modalities to avoid unsuccessful blind pancreatectomy. Intraoperative palpation with the assistance of ultrasound offers a reliable method to precisely locate the insulinoma. Complete surgical resection results in a cure. Recurrent symptoms warrant evaluation for additional lesions.
authors: The Congenital Hyperinsulinism Center and the Department of Surgery at the Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors: William H
authors: WH
authors: Peranteau
authors: Andrew A
authors: AA
authors: Palladino
authors: Tricia R
authors: TR
authors: Bhatti
authors: Susan A
authors: SA
authors: Becker
authors: Lisa J
authors: LJ
authors: States
authors: Charles A
authors: CA
authors: Stanley
authors: N Scott
authors: NS
authors: Adzick
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007340:Insulinoma / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Insulinoma; Intraoperative ultrasound; Localization; Pancreatectomy; Pancreatic tumor; children