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The importance of preoperative localisation procedures in organic hyperinsulinism — Experience in 67 patients

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Summary

Background

Preoperative localisation of insulinomas has been regarded unnecessary, given the significantly higher detection rates of intraoperative ultrasonography and bidigital palpation. These are mandatory before endoscopic surgery.

Methods

67 patients operated on for organic hyperinsulinism were retrospectively analysed regarding tumour localisation within the pancreas, tumour size, histological findings, sensitivities of preoperative imaging methods, and surgical techniques.

Results

59 patients (88%) had solitary insulinomas, four patients (6%) multiple insulinomas and four adult patients (6%) nesidioblastosis. Well-differentiated neuroendocrine tumours with benign behaviour (including four patients with nesidioblastosis) were diagnosed in 53 patients (79%), tumours with uncertain behaviour in nine patients (13%) and well-differentiated neuroendocrine carcinomas in five (8%). Tumours were evenly distributed throughout the pancreas. Endoscopic ultrasound localised tumorus in 15 out of 21 patients (71%), conventional computed tomography (CT) in 7 out of 21 (33%), signleslice helical CT in 7 out of 12 (58%), multidetector CT in 5 out of 5 (100%), magnetic resonance imaging in 11 out of 13 (85%) and angiography in 15 out of 23 (65%). Various combinations of available methods achieved a sensitivity of 88% (49 patients true positive, 4 true negative, 7 false negative). Of 59 patients, solitary insulinomas were enucleated in 47 (80%), 11 patients underwent conventional open resection and one patient endoscopic distal pancreatic resection. Patients with nesidioblastosis or multiple tumours underwent pancreatic resections alone or in combination with enucleations.

Conclusion

After biochemical diagnosis of organic hyperinsulinism, preoperative localisation is necessary for planning endoscopic pancreatic surgery, because of the possibility of multiple insulinomas, malignancy or nesidioblastosis in adults.

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Authors and Affiliations

  1. Section Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Währinger Guertel 18-20, 1090, Vienna, Austria

    Klaus Kaczirek & Bruno Niederle

  2. Department of Radiology, Medical University of Vienna, Vienna, Austria

    Ahmed Ba-Ssalamah & Wolfgang Schima

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  1. Klaus Kaczirek
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  2. Ahmed Ba-Ssalamah
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  3. Wolfgang Schima
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Correspondence to Klaus Kaczirek.

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Kaczirek, K., Ba-Ssalamah, A., Schima, W. et al. The importance of preoperative localisation procedures in organic hyperinsulinism — Experience in 67 patients. Wien Klin Wochenschr 116, 373–378 (2004). https://doi.org/10.1007/BF03040916

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  • DOI: https://doi.org/10.1007/BF03040916

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