Figure 1
Contexts in source publication
Context 1
... surgery, imaging localization study is performed with magnetic resonance imaging (MRI) (Figure 1) which described the presence of a 13 mm lesion at the posterior side of the pancreatic body closed to the superior mesenteric vein (SMV), in absence of vascular infiltration. Endoscopic ultrasound (EUS) confirmed a uT1cN0 lesion with 2 mm distance from the main pancreatic duct (MPD) and at guided fine-needle aspiration (FNA) cytology, a neuroendocrine tumor with MIB1 <1% resulted. ...
Context 2
... particular for superficial small (<20 mm) insulinoma with a minimum distance of 3 mm from MPD, pancreatic spearing enucleation is recommended as treatment of choice (10,19); lymphadenectomy is not generally required, because of high percentage of benignity (14,17). Enucleation in fact, is associated with a significantly reduced incidence of exocrine and endocrine insufficiency, but on the other hand it presents a higher risk of post-operative pancreatic fistula (POPF) (19). ...
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Background and aims
Most pancreatic insulinomas can be treated by minimally invasive modalities. The aim of this meta-analysis was to assess the clinical outcomes of endoscopic ultrasound (EUS)-guided ablation and minimally invasive surgery (MIS) in the treatment of pancreatic insulinoma.
Materials and methods
Online databases were searched for re...
BACKGROUND: Insulinoma is a functional neuroendocrine tumor in the pancreas that can cause hypoglycemia due to endogenic hyperinsulinism. Insulinoma is a rare case with an incidence of 1–4 cases per million people each year. Insulinoma can occur at various ages and mostly occurs in adults with a predominance in women. CASE REPORT: A baby boy aged 1...
Insulinoma, a neuroendocrine tumor originating from pancreatic islets, presents unique challenges in diagnosis and management. We present a case of a 73-year-old female with recurrent hypoglycemia leading to syncope, who underwent emergency pancreatectomy for a secreting insulinoma with multiple comorbidities. This case report aims to shed light on...
Citations
Background
During pancreatic resections assessing tumour boundaries and identifying the ideal resection margins can be challenging due to the associated pancreatic gland inflammation and texture. This is particularly true in the context of minimally invasive surgery, where there is a very limited or absent tactile feedback. Indocyanine green (ICG) fluorescence imaging can assist surgeons by simply providing valuable real-time intraoperative information at low cost with minimal side effects. This meta-analysis summarises the available evidence on the use of near-infrared fluorescence imaging with ICG for the intraoperative visualization of pancreatic tumours (PROSPERO ID: CRD42021247203).
Methods
MEDLINE, Embase, and Web Of Science electronic databases were searched to identify manuscripts where ICG was intravenously administered prior to or during pancreatic surgery and reporting the prevalence of pancreatic lesions visualised through fluorescence imaging.
Results
Six studies with 7 series’ reporting data on 64 pancreatic lesions were included in the analysis. MINOR scores ranged from 6 to 10, with a median of 8. The most frequent indications were pancreatic adenocarcinoma and neuroendocrine tumours. In most cases (67.2%) ICG was administered during surgery. ICG fluorescence identified 48/64 lesions (75%) with 81.3% accuracy, 0.788 (95%CI 0.361-0.961) sensitivity, 1 (95%CI 0.072-1) specificity and positive predictive value of 0.982 (95%CI 0.532-1). In line with the literature, ICG fluorescence identified 5/6 (83.3%) of pancreatic lesions during robotic pancreatic resections performed at our Institution.
Conclusion
This meta-analysis is the first summarising the results of ICG immunofluorescence in detecting pancreatic tumours during surgery, showing good accuracy. Additional research is needed to define optimal ICG administration strategies and fluorescence intensity cut-offs.
