Tags

Type your tag names separated by a space and hit enter

Surgical management of insulinomas in multiple endocrine neoplasia type 1.
Pancreas. 2012 May; 41(4):547-53.P

Abstract

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.

Authors+Show Affiliations

Department of Clinical Physiopathology, Surgical Unit, Medical School, University of Florence, Florence, Italy.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

22228047

Citation

Giudici, Francesco, et al. "Surgical Management of Insulinomas in Multiple Endocrine Neoplasia Type 1." Pancreas, vol. 41, no. 4, 2012, pp. 547-53.
Giudici F, Nesi G, Brandi ML, et al. Surgical management of insulinomas in multiple endocrine neoplasia type 1. Pancreas. 2012;41(4):547-53.
Giudici, F., Nesi, G., Brandi, M. L., & Tonelli, F. (2012). Surgical management of insulinomas in multiple endocrine neoplasia type 1. Pancreas, 41(4), 547-53. https://doi.org/10.1097/MPA.0b013e3182374e08
Giudici F, et al. Surgical Management of Insulinomas in Multiple Endocrine Neoplasia Type 1. Pancreas. 2012;41(4):547-53. PubMed PMID: 22228047.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical management of insulinomas in multiple endocrine neoplasia type 1. AU - Giudici,Francesco, AU - Nesi,Gabriella, AU - Brandi,Maria Luisa, AU - Tonelli,Francesco, PY - 2012/1/10/entrez PY - 2012/1/10/pubmed PY - 2012/8/17/medline SP - 547 EP - 53 JF - Pancreas JO - Pancreas VL - 41 IS - 4 N2 - 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. SN - 1536-4828 UR - https://www.unboundmedicine.com/medline/citation/22228047/Surgical_management_of_insulinomas_in_multiple_endocrine_neoplasia_type_1_ L2 - https://doi.org/10.1097/MPA.0b013e3182374e08 DB - PRIME DP - Unbound Medicine ER -