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What should be done in an operating room when an insulinoma cannot be found?
Author(s) -
Rostambeigi Nassir,
Thompson Geoffrey B.
Publication year - 2009
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.2009.03527.x
Subject(s) - insulinoma , medicine , hyperinsulinism , resection , pancreas , lesion , islet , pancreatectomy , insulin , radiology , surgery , insulin resistance
Summary Insulinoma is the most common (functioning) islet cell tumour of the pancreas and is highly curable with accurate localization and precise extirpation of the often benign, solitary lesion. Although previous reports describe high success rates without pre‐operative localization, more recent recognition of the overlap among causes of endogenous hyperinsulinism, coupled with the deleterious long‐term effects of blind distal pancreatectomy and re‐operation, mandate the need for precise pre‐operative localization or regionalization of the tumour(s). If these criteria have not been met and the surgeon finds him/herself in the operating room without a localized or regionalized tumour, the operation should be concluded without resection, the diagnosis reconfirmed, and a calcium stimulation test performed. At experienced centres, this can be often carried out within 24–48 h and the patient returned to the operating room for a gradient‐guided resection. Intraoperative venous sampling for insulin might be an option in the future but its accuracy has not been validated in sufficient numbers of patients to date.