Surgery for insulinomas
Benign tumours (with no spread beyond the pancreas)
Complete surgical removal of the insulinoma from the pancreas can provide a cure. Most patients have single tumours that can be totally removed (enucleated) without even the need to cut away any part of the healthy pancreas. Often this can be performed via keyhole surgery (laparoscopically).
During surgery, the specialist may perform an intraoperative ultrasound to ensure there are no other small tumours close by or any affected lymph nodes. If the tumour has spread (metastasised) it may still be possible to resect (surgically remove) part of the pancreas containing the tumour and also surgically remove any tumour which may have spread to the liver, which tends to be the main secondary site for these tumours.
All pancreatic surgery in the UK is done in designated specialist pancreatic cancer centres because the operations are complex and require specialist experience, support and after care.
A tablet called Diazoxide can help to elevate and control blood sugar levels whilst you are waiting for your surgery to take place.
Malignant tumours
There are treatment options, including surgery, if you have a malignant tumour that can lead to an improvedquality of life and good control of symptoms
Surgical – surgery may still be considered. It may be possible to resect (surgically remove) part of the pancreas containing the tumour and also surgically remove any tumour which may have spread to the liver, which tends to be the main secondary site for these tumours.
Medical management – if surgery is not possible you may be prescribed a tablet called Diazoxide that can help to elevate and control blood sugar levels.
Types of surgery
Enucleation
This is often done as a keyhole (laparoscopic) operation and by open surgery. The tumour is identified and then carefully dissected away from the pancreas without damaging the pancreas. This is particularly useful for very small slow growing tumours like an insulinoma.
Distal Pancreatectomy
This is also usually a keyhole operation , it is for patients with tumours in the left side ofthe pancreas. It involves removing all or part of the left side of the pancreas (called the body and tail of the pancreas) and sometimes the spleen as well. The blood vessels to the spleen run immediately behind the pancreas so sometimes it is not safe or possible to separate them from the pancreas so the spleen is removed as well. Open surgery is also performed for this procedure.
Whipple’s procedure (pancreatic duodenectomy)
This is a major operation to remove PNETs from the right side of the pancreas (pancreatic head). The head of the pancreas also contains the bile duct and is surrounded by the duodenum (the exit for the stomach) so when the head of the pancreas is removed these organs are removed too. PNETs often involve some of the big blood vessels around the pancreas (portal vein and superior mesenteric vein), parts of these may need to be removed and repaired as well. This means that a lot of re-plumbing is required during the operation to join everything back together again. The operation usually takes 4 to 8 hours to complete. It may take a few months to fully recover from this surgical procedure.