PMID- 11026704
OWN - NLM
STAT- MEDLINE
DCOM- 20010117
LR  - 20191104
IS  - 1435-2443 (Print)
IS  - 1435-2443 (Linking)
VI  - 385
IP  - 5
DP  - 2000 Aug
TI  - Therapeutic experience of 65 cases with organic hyperinsulinism.
PG  - 329-36
AB  - INTRODUCTION: The treatment for insulinoma is enucleation or resection, which are 
      associated with various degrees of morbidity, including fistulas, pseudocysts, 
      and necessity for reoperations. PATIENTS: We evaluated the outcome of 65 patients 
      operated on for organic hyperinsulinism at an experienced university hospital 
      (Department of Surgery, Heinrich-Heine University, Dusseldorf, Germany) between 
      1990 and 1998. Procedures included enucleation (n=37), left-sided resection 
      (n=19), combination of enucleation from the head and left-sided resection (n=4), 
      subtotal left pancreatectomy (n=2), and pancreaticoduodenectomy (n=3). RESULTS: 
      In 47 out of the 65 patients (72%), the expected benign solitary insulinoma was 
      found. Seven patients had malignant tumors and another eight had multiple tumors 
      (including two with multiple endocrine neoplasia type 1 (MEN-1)), and three had 
      nesidioblastosis. In total, 20 patients (31%) developed postoperative drainage of 
      high amylase containing fluid, which in all but three cases resolved with 
      conservative therapy. The three patients who developed fistulas and the three 
      patients who developed pseudocysts underwent reoperative surgery. Seventeen (41%) 
      of the patients who underwent enucleation (10 from the pancreatic head; 50%) and 
      six (25%) of the resected patients demonstrated these complications. 
      Postoperative glucose metabolism was normalized in all patients. CONCLUSION: 
      Resection, especially in the head of the pancreas, demonstrates lower 
      complication rates than enucleation. We propose resection for tumors that are 
      large, malignant, situated close to pancreatic duct, and are multiple, including 
      in MEN-1. For tumors in the head, pancreaticoduodenectomy may be an occasional 
      choice.
FAU - Hellman, P
AU  - Hellman P
AD  - Department of Surgery, Heinrich-Heine University, Dusseldorf, Germany.
FAU - Goretzki, P
AU  - Goretzki P
FAU - Simon, D
AU  - Simon D
FAU - Dotzenrath, C
AU  - Dotzenrath C
FAU - Roher, H D
AU  - Roher HD
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Germany
TA  - Langenbecks Arch Surg
JT  - Langenbeck's archives of surgery
JID - 9808285
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Diagnosis, Differential
MH  - Female
MH  - Humans
MH  - Hyperinsulinism/*etiology
MH  - Insulinoma/*diagnosis/diagnostic imaging/pathology/*surgery
MH  - Male
MH  - Middle Aged
MH  - Multiple Endocrine Neoplasia Type 1/diagnosis/surgery
MH  - *Pancreatectomy/adverse effects/methods
MH  - Pancreatic Diseases/diagnosis/surgery
MH  - Pancreatic Neoplasms/complications/*diagnosis/diagnostic 
      imaging/pathology/*surgery
MH  - *Pancreaticoduodenectomy/adverse effects/methods
MH  - Radiography
MH  - Recurrence
MH  - Retrospective Studies
MH  - Survival Analysis
MH  - Treatment Outcome
EDAT- 2000/10/12 11:00
MHDA- 2001/02/28 10:01
CRDT- 2000/10/12 11:00
PHST- 2000/10/12 11:00 [pubmed]
PHST- 2001/02/28 10:01 [medline]
PHST- 2000/10/12 11:00 [entrez]
AID - 10.1007/s004230000148 [doi]
PST - ppublish
SO  - Langenbecks Arch Surg. 2000 Aug;385(5):329-36. doi: 10.1007/s004230000148.