PMID- 22228047
OWN - NLM
STAT- MEDLINE
DCOM- 20120816
LR  - 20191210
IS  - 1536-4828 (Electronic)
IS  - 0885-3177 (Linking)
VI  - 41
IP  - 4
DP  - 2012 May
TI  - Surgical management of insulinomas in multiple endocrine neoplasia type 1.
PG  - 547-53
LID - 10.1097/MPA.0b013e3182374e08 [doi]
AB  - OBJECTIVE: This study aimed to evaluate the accuracy of preoperative and 
      intraoperative diagnostic tools and the surgical strategy to obtain cure in 
      multiple endocrine neoplasia type 1 (MEN-1) patients affected with insulinoma. 
      METHODS: Eight MEN-1 patients (1992-2009) were operated on for hypoglycemic 
      crisis. Preoperative tumor localization was carried out. Ultrasound and 
      modification of the insulin/glucose (I/G) ratio were applied intraoperatively. 
      Pancreatic lesions larger than 0.5 cm were removed by resection of the most 
      affected pancreatic region and by enucleation of nodules in least affected 
      regions. RESULTS: Two pancreatoduodenectomies and 6 distal pancreatectomies were 
      performed; enucleation of nodules was necessary in 6 patients. There was no 
      postoperative mortality. At the histopathologic analysis, a mean of 6 macrotumors 
      and of 15.5 microlesions were found. Intraoperative ultrasound proved a 
      sensitivity of 87.5% for detecting pancreatic insulinoma. Decrease in the I/G 
      ratio after resection predicted postoperative outcome in all patients. At a mean 
      follow-up of 81.5 months, all patients were normoglycemic with no evidence of 
      disease recurrence. CONCLUSIONS: Multiple endocrine neoplasia type 1 insulinomas 
      should be considered surgically curable. Pancreatic resection seems preferable to 
      a less radical surgical approach in ensuring higher cure rates. Intraoperative 
      ultrasound and I/G ratio are of value in the assessment of surgical decision and 
      in the evaluation of the surgical cure.
FAU - Giudici, Francesco
AU  - Giudici F
AD  - Department of Clinical Physiopathology, Surgical Unit, Medical School, University 
      of Florence, Florence, Italy.
FAU - Nesi, Gabriella
AU  - Nesi G
FAU - Brandi, Maria Luisa
AU  - Brandi ML
FAU - Tonelli, Francesco
AU  - Tonelli F
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PL  - United States
TA  - Pancreas
JT  - Pancreas
JID - 8608542
RN  - 0 (Biomarkers)
RN  - 0 (Blood Glucose)
RN  - 0 (Insulin)
SB  - IM
MH  - Adult
MH  - Biomarkers/blood
MH  - Blood Glucose/metabolism
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Hypoglycemia/blood/etiology
MH  - Insulin/blood
MH  - Insulinoma/complications/diagnosis/*surgery
MH  - Male
MH  - Monitoring, Intraoperative
MH  - Multiple Endocrine Neoplasia Type 1/complications/diagnosis/*surgery
MH  - *Pancreatectomy
MH  - Pancreatic Neoplasms/complications/diagnosis/*surgery
MH  - *Pancreaticoduodenectomy
MH  - Postoperative Complications/epidemiology
MH  - Preoperative Care
MH  - Treatment Outcome
EDAT- 2012/01/10 06:00
MHDA- 2012/08/17 06:00
CRDT- 2012/01/10 06:00
PHST- 2012/01/10 06:00 [entrez]
PHST- 2012/01/10 06:00 [pubmed]
PHST- 2012/08/17 06:00 [medline]
AID - 10.1097/MPA.0b013e3182374e08 [doi]
PST - ppublish
SO  - Pancreas. 2012 May;41(4):547-53. doi: 10.1097/MPA.0b013e3182374e08.