Imaging Features And Surgical Treatment Of35Cases Of Insulinoma

Objective:To review the features of imaging methods and surgical treatment of insulinomas.Methods:The medical records of35patients who had surgery for insulinomas from2004-2012were retrospectively reviewed. All the patients had a definite pathological diagnosis of insulinomas, of whom there were16males and19females aging from20to63years old.Results:Of the35cases, the positive rates for localization were20.0%(2/10),65.4%(17/26),71.4%(15/21),88.9%(8/9),100%(3/3) respectively in transabdominal ultrasound, CT, MRI, endoscopic ultrasound and intraoperative ultrasound.25(71.4%)insulinomas were less than2cm in diameter,3were with multiple insulinomas. Simple enucleation was performed in29cases, of which3were removed via a laparoscopic approach, resection of pancreatic tail in3, resection of pancreatic body and tail in2and PPPD in1.Conclusions:Insulinomas need to be readily localized and the knowledge of the site of the mass before surgery allows to determine whether enucleation of the tumor or pancreatic resection is likely to be required and also whether the tumor is amenable to removal via a laparoscopic approach.EUS is superior to other image examinations before surgery, especially in the diagnosis of small pancreatic insulinomas, and shows the value in the mass location before surgery. Enucleation when possible is the best choice for benign insulinomas and gives the lowest complication rate. Subtotal pancreatectomy is recommended over simple enucleation when come across multiple tumors.