Surgery for gastrinomas The surgical approach to gastrinomas is more complex because these tumors are more frequently malignant and the majority occur outside the pancreas. Tumors in the pancreatic head can often be enucleated, reserving formal pancreaticoduodenectomy for more invasive tumors or those in close proximity to the pancreatic duct or superior mesenteric vessels. Tumors …
What is the appropriate surgical approach for insulinomas? Surgical excision of PNETs remains the only curative treatment. The small size of many insulinomas (< 2 cm) and the rarity of malignancy in these tumors allow for pancreatic parenchymal sparing excision by simple enucleation in most cases. It is becoming increasingly common to utilize a laparoscopic …
How should functional PNETS be imaged? Given the small size of many functional PNETs, preoperative localization can be difficult. Multiphasic CT or MRI is often the first imaging modality pursued. Somatostatin receptor scintigraphy (octreotide scan) is highly sensitive (60%–90%) in locating most PNETs and is especially useful in identifying metastatic disease but is less sensitive …
What are the principles of biochemical testing? When a hormonally active tumor is suspected, the diagnosis should be confirmed biochemically before any imaging is performed. This is important not only for cost-effectiveness but also because some localization studies are invasive. For most biochemical studies an 8-hour fast is recommended. It is important to recognize that …
What are the subtypes and syndromes of functional PNETS? Insulinoma is the most common functional PNET and is malignant in < 10% of cases. The most common presenting symptom is hypoglycemia, causing neuroglycopenic or cardiovascular symptoms. These tumors are found in an even distribution through the entire pancreas. Gastrinoma is the second most common functional …
How common are pancreatic neuroendocrine tumors? Pancreatic neuroendocrine tumors are rare, with an incidence of 0.43 per 100,000 population per year. The incidence in the United States has increased in frequency over the past 30 years because of growing awareness, improvements in diagnostic imaging, and overall increased use of computed tomography (CT) and magnetic resonance …
Complications of bariatric surgery Perioperative (30-day) mortality for bariatric procedures has fallen to approximately 0.1% overall, comparable with that for cholecystectomy or hip replacement. The laparoscopic technique has changed the pattern of perioperative complications. Wound complications and postoperative cardiopulmonary complications are less frequent, whereas anastomotic stenosis, GI bleeding, and bowel obstruction occur more frequently with …