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 approach for simple enucleation. If a patient is not a candidate for enucleation (size, concerning features, proximity to main pancreatic duct), then a formal pancreaticoduodenectomy for tumors in the pancreatic head or a distal pancreatectomy for tumors in the body or tail may be required. When the tumor cannot be localized with preoperative imaging, intraoperative ultrasonography with bimanual palpation has up to 95% sensitivity in localizing the tumor.