Observation Versus Surgery for Nonlocalized Insulinoma
Insulinoma are rare neuroendocrine tumors that almost always occur in the pancreas. They produce symptoms of episodic hypoglycemia secondary to the uncontrolled release of insulin. Using contemporary non-invasive and invasive investigations, insulinoma can be localized in as many as 97% of cases preoperatively. Insulinoma that cannot be localized preoperatively can be identified at the time of surgery with the aid of intraoperative ultrasound in more than 90% of cases and successfully removed. Surgery for insulinoma is associated with significant rates of morbidity (up to 68%), but a low mortality (0–5%). When surgery is not performed, long-term symptom control of hypoglycemia is achieved in only 55–78% of cases using medical management alone. Surgery is therefore recommended for the small percentage of insulinoma that are non-localized, and should be considered preferable to observation. The strength of this recommendation by GRADE criteria is assessed as weak. Given the paucity of evidence in the literature, the overall quality of the evidence supporting this recommendation is assessed as low by GRADE criteria. The investigation and management of patients with insulinoma should be performed at specialized institutions by experienced clinicians.
KeywordsHyperinsulinism Insulinoma Neuroendocrine tumors
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