Insulinoma: Diagnostic strategies and surgical treatment. A 22-year experience

Background/Aims: The efficacy of preoperative localization methods and the results of the surgical treatment of insulinoma were studied. Methodology: Fifty-nine patients referred for surgical treatment were studi ed and the results of the diagnostic tools for tumor localization were comp ared with findings at surgical intervention. The influence of the type of s urgical procedure in the immediate and late postoperative course was also s tudied. Results: Ultrasonography had a sensitivity of 30%, computed tomography 25%, angiography 54%, portal vein sampling 94%, endoscopic ultrasonography 27% and magnetic resonance 17%. Intraoperative palpation localized 98.2% of the tumors and by the addition of intraoperative echography, all lesions were identified. In 55 patients with benign lesions, 22 enucleations, 25 distal pancreatectomies, 7 pancreatectomies plus enucleation and one duodenopancre atectomy were performed. Malignant tumors were treated by pancreatic resect ion, postoperative hepatic artery embolization and systemic chemotherapy. T here was no postoperative mortality. Pancreatic fistula was the most common complication. Three patients who underwent distal pancreatectomy developed latediabetes (9.3%). Conclusions: Extensive preoperative investigation, mainly with invasive met hods, is not indicated and by combining intraoperative palpation and echogr aphy most of the cases can be adequately dealt with. Preservation of pancre atic-tissue with enucleation and preservation of the spleen are the best ch oice for treatment of benign insulinomas.