Abstracts
1998 Digestive Disease Week

#1029

THE ROLE OF INTRAOPERATIVE INSULIN MONITORING IN SURGICAL MANAGEMENT OF INSULINOMA. K. Amikura, R. Nakamura, K. Arai, M. Kobari, S. Matsuno. The First Department of Surgery, Tohoku University School of Medicine, Sendai, Japan.

Thirty-nine patients with insulinomas were surgically treated and evaluated for the efficacy of intraoperative monitoring of immunoreactive insulin (IRI) for surgical management of insulinoma. Patients and methods: The patients, including four patients with multiple tumors (10.3%), had forty-seven tumors. Sixteen tumors (34.0%) were smaller than 1 cm. Perioperative blood glucose monitoring was performed in fourteen patients, intraoperative quick IRI assay for peripheral blood in ten patients and the assay for portal sample in four patients by IMX analyzer. Results: In the patients with multiple insulinomas, six of twelve tumors (50%) were smaller than 1 cm. One tumor 0.2 cm in diameter not localized by intraoperative ultrasonography, was found in a surgical specimen. Three patients required reoperation for residual insulinomas before introduction of intraoperative IRI monitoring and all the tumor were successfully removed in the second operation. Rebound response of blood glucose to insulinoma removal was not always noted (eight of fourteen; 57.1%). Seven of ten patients (70.0%) showed a prompt decrease of peripheral serum IRI levels within 15 minutes after removal of insulinoma, reassuring the surgeons that no insulinomas remained. Four of four patients (100%) showed a decrease in IRI level in portal samples. All the patients had no recurrent insulinoma syndrome after surgical removal of insulinomas. Conclusion: Combined monitoring of peripheral and portal IRI are helpful in surgical management of insulinomas, which could eliminate the need for reoperation due to overlooked insulinomas particularly in the patients with multiple insulinomas.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.