Intraoperative Localization of Pancreatic Insulinoma and IRI Monitoring of Portal Vein

Katsuki Muneoka¹⁾, Kazuhiro Tsukada²⁾, Isao Kurosaki³⁾, Yoshinobu Sato³⁾, Masahiro Ohtake³⁾, Takashi Aono³⁾and Katsuyoshi Hatakeyama³⁾

¹⁾Department of Surgery, Niitsu Medical Center Hospital
²⁾Second Department of Surgery, Toyama Medical and Pharmaceutical University
³⁾First Department of Surgery, Niigata University School of Medicine

Eight patients with a total of 11 insulinomas were examined by ultrasonography (US), computed tomography (CT), angiography, and percutaneous transhepatic portal vein sampling (PTPVS) preoperatively. We discussed preoperative diagnostic accuracy and intraoperative localization. Tumor localization was achieved by US in 55.5%, CT in 55.5%, and angiography in 65%. Three patients underwent tumor extirpation, and 4 distal pancreatectomy. One patient received extirpation and distal pancreatectomy. The surgical strategy for insulinoma is complete resection of the tumor, so not only exact pre- and intra- operative localization but also certification of comlete removal of the tumor are important. After excision of the insulinoma most patients exhibited a definite early hyperglycemic rebound but intraoperative IRI monitoring of the portal vein was ueful for confirmation of tumor excision. All the patients were alive without hypoglycemia or tumor recurrence. The incidence of patients with multiple tumors and malignancy was 25% (2/8) and 12.5% (1/8)respectively.

Key words
insulinoma, intraoperative IRI monitoring, multiple and malignant insulinoma

Reprint requests
Katsuki Muneoka Department of Surgery, Niigata University School of Medicine 1-757 Asahimachi-dori, Niigata City, 951-8510 JAPAN

Accepted
November 29, 2000

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