Surgical management of insulinoma: Diagnosis of tumor location and high incidence of malignancy |
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Authors: | Hidemi Yamauchi MD Kikuo Miyagawa Masamitsu Maeda Seiki Matsuno Toshio Sato |
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Institution: | (1) Department of Surgery, Tohoku University School of Medicine, 980 Sendai, Japan |
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Abstract: | The findings in twenty-two patients with insulinoma were reviewed, as continuous efforts should be made to establish preoperative
localization of the tumor. Superselective arteriography and percutaneous, transhepatic portal vein and pancreatic venous catheterization
are highly recommended approaches. At the time of surgical intervention, a cautious exploration of the pancreas after thorough
mobilization is most important. Recent use of intraoperative ultrasonography increases the likelihood of finding these occult
tumors which locate deeply in the head of the pancreas. Apart from the diagnostic problems, we wish to emphasize the high
incidence of malignancy (7/22, 31.8 per cent) in our series. Althout patients with malignant isulinoma had a much better prognosis
compared to those with a pancreatic ductal malignancy, pancreatic resection with regional lymphnode dissection seems to be
a rational procedure. Enucleation can be done when intraoperative findings of the tumor and regional lymphonode indicate no
malignant features and no multiple lesions. However, at the first operation, enucleation is still a procedure of choice, even
for the malignant insulinoma in the head with a well-defined capsule and no metastatic lesions, the objective being to avoid
a duodenopancreatectomy or total pancreatectomy.
These data were reported at the 30th Congress of Société Internationale de Chirurgie, Hamburg, Germany, 1983 |
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Keywords: | insulinoma tumor location malignant insulinoma |
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