Treatment of Localised Insulinoma Confined to the Pancreas Without Metastatic Disease

Clinical Scenario

This protocol applies to patients with a localised insulinoma confined to the pancreas, with no evidence of metastatic disease. Surgical resection is the gold standard treatment for this presentation.

Clinical Goal

Cure of the localised insulinoma with resolution of hypoglycaemia.

Treatment approach: The primary strategy involves parenchyma-sparing pancreatic resection, with the preferred route being a minimally invasive approach where technically feasible. The specific procedure and candidacy criteria depend on tumour size, location, and proximity to key pancreatic structures. An alternative non-surgical approach may also be considered in selected patients.

Full procedural criteria, surgical options, and decision algorithm available in the complete protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/jne.13318

Surgical resection is the gold standard treatment for localised insulinomas.

Parenchyma-sparing pancreatic resections should be proposed as first-line surgical strategy, when technically feasible.

Enucleation can be proposed to patients with insulinomas smaller than 2–3 cm and located at ≥3 mm from the MPD.

Central pancreatectomy represents a valuable option for patients with insulinomas located in the pancreatic neck, when enucleation is not feasible, and the remaining parenchyma is enough to guarantee a relevant pancreatic function.

Therefore, a minimally invasive approach should be always considered, when technically feasible, for patients with preoperatively localised insulinomas.

On the other hand, open surgery with intraoperative ultrasound is required when insulinomas are not localised preoperatively.

EUS-RFA might be considered as treatment option in patients with small (≤2 cm) localised insulinomas considered as unfit for surgery.

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