ABSTRACT
AIM: To determine the optimal surgical approach to insulin-producing pancreatic tumors via an analysis of early postoperative results. MATERIAL AND METHODS: There were 134 patients with insulin-producing pancreatic tumors followed by organic hyperinsulinism who have undergone surgery in the faculty-based surgical clinic of the Sechenov First Moscow State Medical University for the period 1990-2017. Patients were divided into three groups depending on type of surgical intervention. Surgical procedure was determined after comprehensive preoperative and intraoperative examination including intraoperative ultrasound. RESULTS: Incidence of postoperative complications was 32.8%. Ten (7.5%) patients required redo surgical interventions. Overall postoperative mortality was 4.5%. The best immediate results were observed in patients undergoing distal pancreatectomy. There was a correlation between incidence of early postoperative complications and tumor location depth in the enucleation group. CONCLUSION: Enucleation is advisable for insulinoma of pancreatic head or uncinated process, as well as superficial tumors of the left half of the pancreas. Distal pancreatectomy is indicated for deep tumors of the left half of the pancreas. Indications for pancreatoduodenectomy are individual.
Subject(s)
Hyperinsulinism/surgery , Insulinoma/surgery , Pancreatectomy/methods , Pancreatic Neoplasms/surgery , Choice Behavior , Clinical Decision-Making , Humans , Hyperinsulinism/etiologySubject(s)
Catheter Ablation/methods , Insulinoma/surgery , Microwaves/therapeutic use , Pancreatectomy/methods , Pancreatic Neoplasms/surgery , Surgery, Computer-Assisted/methods , Aged, 80 and over , Humans , Insulin/metabolism , Insulin Secretion , Insulinoma/diagnostic imaging , Insulinoma/metabolism , Male , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/metabolism , Tomography, X-Ray Computed , UltrasonographyABSTRACT
N.N. Burdenko surgery clinic have an experience of treatment of 342 patients with gastroenteropancreatic neuroendocrine tumors. Original algorithms of diagnosis, complex treatment and postoperative management were applied. We achieved 100% five-year survival rate after radical surgery and reduced postoperative complications 1.6 times.
Subject(s)
Biological Therapy/methods , Diagnostic Imaging , Hospitals, Teaching , Neuroendocrine Tumors/therapy , Pancreatectomy/methods , Pancreatic Neoplasms/therapy , Adolescent , Adult , Aged , Algorithms , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Moscow/epidemiology , Neuroendocrine Tumors/diagnosis , Neuroendocrine Tumors/epidemiology , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/epidemiology , Retrospective Studies , Survival Rate/trends , Time Factors , Young AdultABSTRACT
The clinic obtains the experience of treatment of 245 patients with organic hyperinsulinism. The main goal of the treatment of that category of patients is an improvement of immediate results of surgical treatment which leads to the decrease in mortality level. Authors set the diagnostic and intra- and postoperative treatment algorithm, as well as the major prognostic factors of postoperative morbidity rates. The use of the algorithm allowed the 1,5 decrease in postoperative morbidity and twice decreased the lethality rate.
