ПОВТОРНЫЕ ОПЕРАТИВНЫЕ ВМЕШАТЕЛЬСТВА ПРИ ИНСУЛИНОМАХ

Abstract

Insulinoma is the most common pancreatic neuroendocrine tumor. Surgical management of insulinomas is considered to be the only curative method. However pancreatic surgery is associated with postoperative complications. The most difficult category of patients is patients previously operated on the pancreas. The aim is to show our experience of treatment patients with reoperated insulinomas. Materials and methods. 201 patients were operated because of insulinoma in the abdominal surgery department of Sechenov University from 1993 to 2019. 18 patients of them were reoperated. The authors describe their treatment experience of this category of patients. Results. The rate of reoperations in pancreatic insulinomas was 9%. Most of the tumors (12 of 18) were located in the head. Six patients were reoperated due to newly developed insulinomas. 12 patients were previously operated in other clinics but the tumors were not detected. This group of patients were the most complicated in imaging so we had to apply selective intra-arterial calcium stimulation test. All reoperated patients developed destructive pancreatitis in the postoperative period, five patients developed pancreatic fistula of classes B and C, two patients died. Conclusion. Accurate preoperative imaging carried out by an experienced team in reference center is an important factor for reducing the level of postoperative complications. Patients who had pancreatic surgery before should be treated by experienced multidisciplinary team.