Background: The majority of insulinomas are benign, small and intrapancreatic. Preoperative localisation is important to plan the surgical management. Methods: We retrospectively analysed our data on the preoperative imaging, type of surgery and histopathological features of the operated patients with an insulinoma from January 1993 to March 2010. Univariate and multivariate analyses were performed to detect the predictive factors for survival following surgery. Results: Forty patients were operated on for insulinoma, of which 33 were benign and 7 were malignant. The sensitivity of preoperative computed tomogram scan, magnetic resonance imaging and endoscopic ultrasound, for localising the lesions was 62, 82 and 94%, respectively. Enucleation was performed in 21 (52.5%) patients, and remaining had pancreatic resection. Hepatic resection was performed in 2 and liver transplantation in 1 patient. Morbidity and perioperative mortality was 17 (42.5%) and 1 (2.7%), respectively. The overall 5- and 10-year survival was 89 and 86.5%, respectively. The presence of metastases was found to be an independent predictor of poor survival on multivariate analysis. Conclusion: Preoperative computed tomogram/magnetic resonance imaging and endoscopic ultrasound are sensitive in localizing the majority of insulinomas. Surgery offers a good long-term survival, even in patients with malignant insulinoma.

Jani N, Moser AJ, Khalid A: Pancreatic endocrine tumors. Gastroenterol Clin North Am 2007;36:431–439, x–xi.
Grant CS: Insulinoma. Best Pract Res Clin Gastroenterol 2005;19:783–798.
Tucker ON, Crotty PL, Conlon KC: The management of insulinoma. Br J Surg 2006;93:264–275.
Service FJ, Natt N: The prolonged fast. J Clin Endocrinol Metab. 2000;85:3973–3974.
Doherty GM, Doppman JL, Shawker TH, Miller DL, Eastman RC, Gorden P, et al: Results of a prospective strategy to diagnose, localize, and resect insulinomas. Surgery 1991;110:989–996; discussion 996–997.
Pasieka JL, McLeod MK, Thompson NW, Burney RE: Surgical approach to insulinomas. Assessing the need for preoperative localization. Arch Surg 1992;127:442–447.
Grama D, Eriksson B, Mårtensson H, Cedermark B, Ahrén B, Kristoffersson A, et al: Clinical characteristics, treatment and survival in patients with pancreatic tumors causing hormonal syndromes. World J Surg 1992;16:632–639.
Menegaux F, Schmitt G, Mercadier M, Chigot JP: Pancreatic insulinomas. Am J Surg 1993;165:243–248.
Service FJ, McMahon MM, O’Brien PC, Ballard DJ: Functioning insulinoma – incidence, recurrence, and long-term survival of patients: a 60-year study. Mayo Clin Proc 1991;66:711–719.
Stephen AE, Hodin RA: Neuroendocrine tumors of the pancreas, excluding gastrinoma. Surg Oncol Clin N Am 2006;15:497–510.
Hirshberg B, Libutti SK, Alexander HR, Bartlett DL, Cochran C, Livi A, et al: Blind distal pancreatectomy for occult insulinoma, an inadvisable procedure. J Am Coll Surg 2002;194:761–764.
Goh BK, Ooi LL, Cheow PC, Tan YM, Ong HS, Chung YF, et al: Accurate preoperative localization of insulinomas avoids the need for blind resection and reoperation: analysis of a single institution experience with 17 surgically treated tumors over 19 years. J Gastrointest Surg 2009;13:1071–1077.
Norton JA, Shawker TH, Doppman JL, Miller DL, Fraker DL, Cromack DT, et al: Localization and surgical treatment of occult insulinomas. Ann Surg 1990;212:615–620.
Howland G, Campbell WR, Maltby EJ, Robinson WL: Dysinsulinism: Convulsions and coma due to an islet cell tumor of the pancreas with operation and cure. JAMA 1929;93:674–679.
Rothmund M, Angelini L, Brunt LM, Farndon JR, Geelhoed G, Grama D, et al: Surgery for benign insulinoma: an international review. World J Surg 1990;14:393–398; discussion 398–399.
Boukhman MP, Karam JM, Shaver J, Siperstein AE, DeLorimier AA, Clark OH: Localization of insulinomas. Arch Surg 1999;134:818–822; discussion 822–823.
Lo CY, Lam KY, Kung AW, Lam KS, Tung PH, Fan ST: Pancreatic insulinomas. A 15-year experience. Arch Surg 1997;132:926–930.
Solcia E, Klöppel G, Sobin LH, Capella C, DeLellis RA, Heitz PU, et al: Histological Typing of Endocrine Tumours (WHO. World Health Organization. International Histological Classification of Tumours), ed 2. New York, Springer, 2000.
Heymann MF, Joubert M, Nemeth J, Franc B, Visset J, Hamy A, et al: Prognostic and immunohistochemical validation of the Capella classification of pancreatic neuroendocrine tumours: an analysis of 82 sporadic cases. Histopathology 2000;36:421–432.
Klöppel G, Perren A, Heitz PU: The gastroenteropancreatic neuroendocrine cell system and its tumors: the WHO classification. Ann NY Acad Sci 2004;1014:13–27.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al: Postoperative pancreatic fistula: an international study group (ISGPF) definition. International Study Group on Pancreatic Fistula Definition. Surgery 2005;138:8–13.
Nikfarjam M, Warshaw AL, Axelrod L, Deshpande V, Thayer SP, Ferrone CR, et al: Improved contemporary surgical management of insulinomas: a 25-year experience at the Massachusetts General Hospital. Ann Surg 2008;247:165–172.
Boukhman MP, Karam JH, Shaver J, Siperstein AE, Duh QY, Clark OH: Insulinoma–experience from 1950 to 1995. West J Med 1998;169:98–104.
Daggett PR, Kurtz AB, Morris DV, Goodburn EA, Le Quesne LP, Nabarro JDN, et al: Is preoperative localisation of insulinomas necessary? Lancet 1981;317:483–486.
Hashimoto LA, Walsh RM: Preoperative localization of insulinomas is not necessary. J Am Coll Surg 1999;189:368–373.
Gouya H, Vignaux O, Augui J, Dousset B, Palazzo L, Louvel A, et al: CT, endoscopic sonography, and a combined protocol for preoperative evaluation of pancreatic insulinomas. Am J Roentgenol 2003;181:987–992.
Fidler JL, Fletcher JG, Reading CC, Andrews JC, Thompson GB, Grant CS, Service FJ: Preoperative detection of pancreatic insulinomas on multiphasic helical CT. Am J Roentgenol 2003;181:775–780.
King AD, Ko GT, Yeung VT, Chow CC, Griffith J, Cockram CS: Dual phase spiral CT in the detection of small insulinomas of the pancreas. Br J Radiol 1998;71:20–23.
Moore NR, Rogers CE, Britton BJ: Magnetic resonance imaging of endocrine tumours of the pancreas. Br J Radiol 1995;68:341–347.
Owen NJ, Sohaib SA, Peppercorn PD, Monson JP, Grossman AB, Besser GM, Reznek RH: MRI of pancreatic neuroendocrine tumours. Br J Radiol 2001;74:968–973.
Hamoud AK, Khan MF, Aboalmaali N, Usadel KH, Wullstein C, Vogl TJ: Mangan-enhanced MR imaging for the detection and localisation of small pancreatic insulinoma. Eur Radiol 2004;14:923–925.
McLean AM, Fairclough PD: Endoscopic ultrasound in the localisation of pancreatic islet cell tumours. Best Pract Res Clin Endocrinol Metab 2005;19:177–193.
Hiramoto JS, Feldstein VA, LaBerge JM, Norton JA: Intraoperative ultrasound and preoperative localization detects all occult insulinomas. Arch Surg 2001;136:1020–1025.
Wong M, Isa SH, Zahiah M, Azmi KN: Intraoperative ultrasound with palpation is still superior to intra-arterial calcium stimulation test in localising insulinoma. World J Surg 2007;31:586–592.
Angelini L, Bezzi M, Tucci G, Lirici MM, Candiani F, Rubaltelli L, et al: The ultrasonic detection of insulinomas during surgical exploration of the pancreas. World J Surg 1987;11:642–647.
Pasieka JL, McLeod MK, Thompson NW, Burney RE: Surgical approach to insulinomas. Assessing the need for preoperative localization. Arch Surg 1992;127:442–447.
Norton JA, Sigel B, Baker AR, Ettinghausen SE, Shawker TH, Krudy AG, et al: Localization of an occult insulinoma by intraoperative ultrasonography. Surgery 1985;97:381–384.
Doherty GM, Doppman JL, Shawker TH, Miller DL, Eastman RC, Gorden P, et al: Results of a prospective strategy to diagnose, localize, and resect insulinomas. Surgery 1991;110:989–996.
Soga J, Yakuwa Y, Osaka M: Insulinoma/hypoglycemic syndrome: a statistical evaluation of 1085 reported cases of a Japanese series. J Exp Clin Cancer Res 1998;17:379–388.
Iacono C, Bortolasi L, Facci E, Nifosì F, Pachera S, Ruzzenente A, et al: The Dagradi-Serio-Iacono operation central pancreatectomy. J Gastrointest Surg 2007;11:364–376.
Lo CY, Chan WF, Lo CM, Fan ST, Tam PKH: Surgical treatment of pancreatic insulinomas in the era of laparoscopy. Surg Endosc 2004;18:297–302.
Danforth DN Jr, Gorden P, Brennan MF: Metastatic insulin-secreting carcinoma of the pancreas: clinical course and the role of surgery. Surgery 1984;96:1027–1037.
Gagner M, Pomp A, Herrera MF: Early experience with laparoscopic resections of islet cell tumors. Surgery 1996;120:1051–1054.
Tomassetti P, Campana D, Piscitelli L, Casadei R, Santini D, Nori F, et al: Endocrine pancreatic tumors: factors correlated with survival. Ann Oncol 2005;16:1806–1810.
Gupta S, Johnson MM, Murthy R, Ahrar K, Wallace MJ, Madoff DC, et al: Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors: variables affecting response rates and survival. Cancer 2005;104:1590–1602.
Le Treut YP, Delpero JR, Dousset B, Cherqui D, Segol P, Mantion G, et al: Results of liver transplantation in the treatment of metastatic neuroendocrine tumors. A 31-case French multicentric report. Ann Surg 1997;225:355–364.
Liu H, Peng C, Zhang S, Wu Y, Fang H, Sheng H, Peng S: Strategy for the surgical management of insulinomas: analysis of 52 cases. Dig Surg 2007;24:463–470.
Kazanjian KK, Reber HA, Hines OJ: Resection of pancreatic neuroendocrine tumors: results of 70 cases. Arch Surg 2006;141:765–769.
Bilimoria KY, Talamonti MS, Tomlinson JS, Stewart AK, Winchester DP, Ko CY, et al: Prognostic score predicting survival after resection of pancreatic neuroendocrine tumors: analysis of 3851 patients. Ann Surg 2008;247:490–500.
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