What is the role of surgery in the treatment of metastatic insulinoma?

Updated: May 31, 2020
  • Author: Zonera Ashraf Ali, MBBS; Chief Editor: Neetu Radhakrishnan, MD  more...
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Answer

Insulinomas are found to be metastatic at surgery in about 5-10% of patients. It would be extremely uncommon for metastases to develop in a case in which only a solitary lesion was found on initial presentation.

Patients who are responsive to diazoxide should be continued on it while more invasive imaging studies are performed, before repetitive surgery is considered. If the patient is not responsive (5-10%) or if drug intolerance is present and ectopic disease is excluded, a blind distal two-thirds pancreatectomy may be performed. However, this procedure has only a 25% success rate.

Most authorities recommend serial sectioning during resection. Tumors that are not found at surgery normally are located in the pancreatic head (54%), body (20%), and tail (14%).

Even when metastases are found, surgical excision is often feasible before any medical, chemotherapeutic, or other interventional therapy is considered. Resect all gross disease, including wedge resections of hepatic metastases. Avoid ligation of the hepatic artery in case further regional infusion therapy becomes necessary.


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