World Journal of Surgery

, Volume 28, Issue 12, pp 1239–1247

Laparoscopic Pancreatic Surgery for Islet Cell Tumors of the Pancreas

Article

Abstract

The experience with laparoscopic pancreatic surgery (LPS) in general, and pancreatic islet cell tumors (ICTs) in particular, is still limited. Because insulinoma is the most prevalent tumor and is mostly benign, single, and curable with surgical excision, it comprises most of the cases. Our experience with 17 cases (10 insulinomas, 2 gastrinomas, 1 nesidioblastoma, 4 nonfunctioning tumors) and those recorded in the literature (93 cases) show that laparoscopic surgery for small, solitary benign islet cell tumors located in the body and tail is feasible and safe and can result in rapid postoperative recuperation and a complication rate comparable or lower than that achieved with open surgery. It duplicates the success rate seen with conventional surgery regarding intraoperative localization and cure of disease. The main morbidity continues to be the occurrence of a fistula (18%), most often after enucleation, but the clinical course is benign in most instances. Preoperative imaging studies are required for localization, and the combined use of biphasic helical computed tomography and endoscopic ultrasonography (US) seems to be cost-effective. The use of laparoscopic US is an integral part of the laparoscopic procedure, and the information achieved is valuable for both confirming localization and decision making concerning the most appropriate surgical procedure. In cases of distal pancreatectomy, splenic salvage, preferably with preservation of splenic vessels, is feasible albeit more demanding and can be achieved in most cases.

References

  1. 1.
    Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy [abstract]. In Proceedings of the Second Annual Congress, Canadian Society for Endoscopic and Laparoscopic Surgery, Ottawa, Sepember 1992;26–29Google Scholar
  2. 2.
    Gagner, M, Pomp, A, Herrera, MF 1996Early experience with laparoscopic resections of islet cell tumorsSurgery12010511054PubMedGoogle Scholar
  3. 3.
    Park, A, Heniford, BT 2002Therapeutic laparoscopy of the pancreasAnn. Surg.236149158CrossRefPubMedGoogle Scholar
  4. 4.
    Fernandez-Cruz, L, Saenz, A, Astudillo, E,  et al. 2002Outcome of laparoscopic pancreatic surgery: endocrine and non-endocrine tumorsWorld J. Surg.2610571065CrossRefPubMedGoogle Scholar
  5. 5.
    Fabre, JM, Dulucq, JL, Vacher, C,  et al. 2002Is laparoscopic left pancreatic resection justified?Surg. Endosc.1613581361CrossRefPubMedGoogle Scholar
  6. 6.
    Fernandez-Cruz, L, Saenz, A, Astudillo, E,  et al. 2002Laparoscopic pancreatic surgery in patients with chronic pancreatitisSurg. Endosc.169961003CrossRefPubMedGoogle Scholar
  7. 7.
    Fernandez-Cruz, L, Herrera, M, Saenz, M,  et al. 2001Laparoscopic pancreatic surgery in patients with neuroendocrine tumors: indications and limitsClin. Endocrinol. Metab.15161175CrossRefGoogle Scholar
  8. 8.
    Patterson, EJ, Gagner, M, Salky, B,  et al. 2001Laparoscopic pancreatic resection: single-institution experience of 19 patientsJ. Am. Coll. Surg.193281287CrossRefPubMedGoogle Scholar
  9. 9.
    Gagner, M, Pomp, A 1997Laparoscopic pancreatic resection: is it worthwhile?J. Gastrointest. Surg.12026CrossRefPubMedGoogle Scholar
  10. 10.
    Cuschieri, A 2000Laparoscopic hand-assisted surgery for hepatic and pancreatic diseaseSurg. Endosc.14991996CrossRefPubMedGoogle Scholar
  11. 11.
    Cuschieri, A, Jakimowicz, JJ, Spreeuwel, J 1996Laparoscopic distal 70% pancreatectomy and splenectomy for chronic pancreatitisAnn. Surg.223280285CrossRefPubMedGoogle Scholar
  12. 12.
    Kaplan LM, Fauci AS, Braunwald E. Endocrine tumors of the gastrointestinal tract and pancreas. In Harrison’s Principles of Internal Medicine, 14th edition, New York, McGraw-Hill, 1999;584–592Google Scholar
  13. 13.
    Geoghean, G, Jackson, JE, Lewis, MPN,  et al. 1994Localization and surgical management of insulinomasBr. J. Surg.8110251028PubMedGoogle Scholar
  14. 14.
    Hellman, P, Goretzki, P, Simon, D,  et al. 2000Therapeutic experience of 65 cases with organic hyperinsulinismLangenbecks Arch. Surg.385329336CrossRefPubMedGoogle Scholar
  15. 15.
    Lo, CY, Lam, KY, Kung, AW,  et al. 1997Pancreatic insulinoma: a 15-year experienceArch. Surg.132926930PubMedGoogle Scholar
  16. 16.
    Huai, JC, Zhang, W, Niu, HO,  et al. 1998Localization and surgical treatment of pancreatic insulinomas guided by intraoperative ultrasoundAm. J. Surg.1751821CrossRefPubMedGoogle Scholar
  17. 17.
    Evans, DB, Skibber, JM, Lee, JE,  et al. 1993Non-functioning islet cell carcinoma of the pancreasSurgery11411751181PubMedGoogle Scholar
  18. 18.
    Gramatica, L, Herrera, MF, Mercado-Luna, A,  et al. 2002Videolaparoscopic resection of insulinomas: experience in two institutionsWorld J. Surg.2612971300CrossRefPubMedGoogle Scholar
  19. 19.
    Brendes, FJ, Cuesta, MA, Kazemier, G,  et al. 2000Laparoscopic detection and resection of insulinomasSurgery128386391CrossRefPubMedGoogle Scholar
  20. 20.
    Mahon, D, Allen, E, Rhodes, M 2002Laparoscopic distal pancreatectomy: three cases of insulinomaSurg. Endosc.16700702CrossRefPubMedGoogle Scholar
  21. 21.
    Lo, CY, Lo, CM, Fan, ST 2000Role of laparoscopic ultrasonography in intraoperative localization of pancreatic insulinomaSurg. Endosc.1411311135CrossRefPubMedGoogle Scholar
  22. 22.
    Chapuis, Y, Bigourdan, JM, Massault, PP,  et al. 1998Videolaparoscopic resection of insulinoma: report of five casesChirurgie123461467PubMedGoogle Scholar
  23. 23.
    Iihara, M, Kanbe, M, Okamoto, T,  et al. 2001Laparoscopic ultrasonography for resection of insulinomasSurgery13010861091CrossRefPubMedGoogle Scholar
  24. 24.
    Cuschieri, A, Jakimowicz, JJ, Stultiens, G 1998Laparoscopic infracolic approach for complications of acute pancreatitisSemin. Laparosc. Surg.5189194PubMedGoogle Scholar
  25. 25.
    Tagaya, N, Kasama, K, Suzuki, N,  et al. 2002Laparoscopic resection of the pancreas and review of the literatureSurg. Endosc.17201206CrossRefPubMedGoogle Scholar
  26. 26.
    Spitz, JD, Lilly, MC, Tetik, C,  et al. 2000Ultrasound-guided laparoscopic resection of pancreatic islet cell tumorsSurg. Laparosc. Endosc.10168173CrossRefGoogle Scholar
  27. 27.
    Nieuwenhove, Y, Delvaux, G 1999Laparoscopic management of neuroendocrine tumors of the pancreasActa Chir. Belg.99249252PubMedGoogle Scholar
  28. 28.
    Collins, R, Schlinkert, T, Roust, L 1999Laparoscopic resection of an insulinomaJ Laparoendosc Adv Surg Tech9429431Google Scholar
  29. 29.
    Dexter, SP, Martin, IG, Leindler, L,  et al. 1999Laparoscopic enucleation of a solitary pancreatic insulinomaSurg. Endosc.13406408CrossRefPubMedGoogle Scholar
  30. 30.
    Furihata, M, Tagaya, N, Kubota, K 2001Laparoscopic enucleation of insulinoma in the pancreasSurg. Laparosc. Endosc.11279283Google Scholar
  31. 31.
    Sussman, LA, Christie, R, Whittle, DE 1996Lparoscopic excision of distal pancreas including insulinomaAust. N. Z. J. Surg.66414416PubMedGoogle Scholar
  32. 32.
    Tgaya, N, Ishikawa, K, Kubota, K 2002Spleen-preserving laparoscopic distal pancreatectomy with conservation of the splenic artery and vein for a large insulinomaSurg. Endosc.16217218CrossRefGoogle Scholar
  33. 33.
    Takamatsu, F, Teramoto, K, Inoue, H,  et al. 2002Laparoscopic enucleation of an insulinoma of the pancreas tailSurg. Endosc.16217CrossRefGoogle Scholar
  34. 34.
    Tihanyi, F, Morvay, K, Nehez, L,  et al. 1997Laparoscopic distal resection of the pancreas with the preservation of the spleenActa Chir. Hung.36359361Google Scholar
  35. 35.
    Vezakis, A, Davides, M, Larvin, M,  et al. 1999Laparoscopic surgery combined with preservation of the spleen for distal pancreatic tumorsSurg. Endosc.132629CrossRefPubMedGoogle Scholar
  36. 36.
    Yoshida, T, Bandoh, T, Ninomiya, K,  et al. 1998Laparoscopic enucleation of a pancreatic insulinoma: report of a caseSurg. Today2811811191Google Scholar
  37. 37.
    Chapuis Y, Dousset B. Laparoscopic enucleation of of islet tumors of the pancreas. In Gagner M, Inabnet WB, editors, Minimally Invasive Endocrine Surgery, Philadelphia, Lippincott Williams & Wilkins, 2002;273–281Google Scholar
  38. 38.
    Palazzo, L, Roseau, G, Salmeron, M 1992Endoscopic ultrasonography in the preoperative localization of insulinomasEndoscopy24350355PubMedGoogle Scholar
  39. 39.
    Pitre, J, Chapuis, Y, Soubrane, O,  et al. 1996Endoscopic ultrasonography for the preoperative localization of insulinomasPancreas135560PubMedGoogle Scholar
  40. 40.
    Dolan, JP, Norton, JA 2000Occult insulinomaBr. J. Surg.87385387CrossRefPubMedGoogle Scholar
  41. 41.
    Meko, JB, Norton, JA 1994Endocrine tumors of the pancreasCurr. Opin. Gen. Surg.2186194Google Scholar
  42. 42.
    Schumacher, B, Lubke, HJ, Frieling, T,  et al. 1996Prospective study on the detection of insulinomas by endoscopic ultrasonographyEndoscopy28273276PubMedGoogle Scholar
  43. 43.
    Brown, CK, Bartlett, DL, Doppman, JL,  et al. 1997Intra-arterial calcium stimulation and intraoperative ultrasonography in the localization and resection of insulinomasSurgery12211891194CrossRefPubMedGoogle Scholar
  44. 44.
    Norton, JA, Cromack, DT, Shawter, TH,  et al. 1988Intraoperative ultrasonographic localization of islet cell tumorsAnn. Surg.207160168PubMedGoogle Scholar
  45. 45.
    Heerden, JA, Grant, CS, Czako, PF,  et al. 1992Occult functioning insulinomas : which localization studies are indicated ?Surgery11210101014PubMedGoogle Scholar
  46. 46.
    Norton, JA, Shawker, TH, Doppman, JL,  et al. 1990Localization and surgical treatment of occult insulinomasAnn. Surg.212615620PubMedGoogle Scholar
  47. 47.
    Hiramoto, JS, Feldstein, VA, LaBerge, JM,  et al. 2001Intraoperative ultrasound and preoperative localization detects all occult insulinomasArch. Surg.13610201026CrossRefPubMedGoogle Scholar
  48. 48.
    Shinchi, H, Takao, S, Noma, H,  et al. 2001Hand-assisted laparoscopic distal pancreatectomy with mini-laparotomy for distal pancreatic cystadenomaSurg. Laparosc. Endosc. Percutan. Tech.11139143CrossRefPubMedGoogle Scholar
  49. 49.
    Holloran, CM, Ghanch, P, Bossennet, L,  et al. 2002Complications of pancreatic cancer resectionDig. Surg.19138146CrossRefPubMedGoogle Scholar
  50. 50.
    Bassi, C, Falconi, M, Salvia, R,  et al. 2000Role of octreotide in the treatment of external pancreatic pure fistulas: a single institution prospective experienceLangenbecks Arch. Surg.3851013CrossRefPubMedGoogle Scholar
  51. 51.
    Matsumoto, T, Kitano, S, Yoshida, T,  et al. 1999Laparoscopic resection of a pancreatic mucinous cystadenoma using laparoscopic coagulation shearsSurg. Endosc.13172173CrossRefPubMedGoogle Scholar
  52. 52.
    Ueno, T, Oka, M, Nishihara, K,  et al. 1999Laparoscopic distal pancreatectomy with preservation of the spleenSurg. Laparosc. Endosc.9290293CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2004

Authors and Affiliations

  1. 1. Department of SurgeryWeill Medical College of Cornell University, New York-Presbyterian HospitalNew YorkUSA

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