Yonsei Med J.  2008 Oct;49(5):864-868. 10.3349/ymj.2008.49.5.864.

Laparoscopic Enucleation of a Nonfunctioning Neuroendocrine Tumor of the Pancreas

• Kang CM
• Lee KG
• Pyo JY
• Lee SW
• Kim KS
• Choi JS
• Lee WJ
• Kim BR

• KMID: 2158209
• DOI: http://doi.org/10.3349/ymj.2008.49.5.864

Abstract

Laparoscopic approaches are increasingly used in pancreatic surgery. In the treatment of neuroendocrine tumors (NETs) of the pancreas, enucleation is one of the recommended surgery. Although many clinical experiences have reported the safety and efficacy of laparoscopic enucleation of functioning NETs, such as insulinomas, few reports have explored such treatment for non-functioning NETs. Here, we present a case of 70-year old female patient who underwent successful laparoscopic enucleation of a nonfunctioning NET located in the body of the pancreas.

Keyword

Laparoscopy; enucleation; neuroendocrine tumor; pancreas

MeSH Terms

Aged
Female
Humans
*Laparoscopy
Neuroendocrine Tumors/pathology/*surgery/ultrasonography
Pancreatic Neoplasms/pathology/*surgery/ultrasonography

Figure

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  Fig. 1 Abdominal CT scan. About 1 cm-sized enhanced mass is noted in the surface of the pancreatic body.

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  Fig. 2 Endoscopoic Ultrasonogram. About 1 cm-sized, single, homogenous, hypoechoic mass was found in the pancreatic body.

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  Fig. 3 Trocar placement.

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  Fig. 4 Intraoperative laparoscopic view. Superficial locating, well-demarcated pancreatic mass is noted in the body of pancreas (A). Enucleation of the pancreatic mass is achieved (B and C). Gross pathologic finding. It was about 1cm sized homogenous well demarcating mass (D).

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  Fig. 5 Hematoxylin-Eosin staining (× 200).

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  Fig. 6 Immunohistochemstry with chromogranin A (× 200).

Reference

1. Shimizu S, Tanaka M, Konomi K, Mizumoto K, Yamaguchi K. Laparoscopic pancreatic surgery: current indications and surgical results. Surg Endosc. 2004. 18:402–406.

2. Park A, Schwartz R, Tandan V, Anvari M. Laparoscopic pancreatic surgery. Am J Surg. 1999. 177:158–163.

3. Cuschieri A. Laparoscopic surgery of the pancreas. J R Coll Surg Edinb. 1994. 39:178–184.

4. Fernandez-cruz L, Saenza A, Pantoja JP. Laparoscopy in pancreatic surgery. Int J Surg Sci. 2000. 7:1. 121.

5. Toniato A, Meduri F, Foletto M, Avogaro A, Pelizzo M. Laparoscopic treatment of benign insulinomas localized in the body and tail of the pancreas: a single-center experience. World J Surg. 2006. 30:1916–1919. discussion 1920-1.

6. Dakin GF, Inabnet WB. Multimedia article. Laparoscopic enucleation of a pancreatic insulinoma. Surg Endosc. 2004. 18:1680.

7. Bozbora A, Barbaros U, Erbil Y, Ozarmagan S, Mercan S. Is laparoscopic enucleation the gold standard in selected cases with insulinoma? J Laparoendosc Adv Surg Tech A. 2004. 14:230–233.

8. Lo CY, Chan WF, Lo CM, Fan ST, Tam PK. Surgical treatment of pancreatic insulinoma in the era of laparoscopy. Surg Endosc. 2004. 18:297–302.

9. Stein DM, Licht AL, Gecelter GR. Laparoscopic enucleation of an insulinoma: advantages of using the curved laparoscopic coagulating shears. Surg Endosc. 2002. 16:1365.

10. Takamatsu S, Teramoto K, Inoue H, Goseki N, Takahashi S, Baba H, et al. Laparoscopic enucleation of an insulinoma of the pancreas tail. Surg Endosc. 2002. 16:217.

11. Kang CM, Kim KS, Choi JS, Lee WJ, Kim BR. Experiences with nonfunctioning neuroendocrine neoplasms of the pancreas. Dig Surg. 2005. 22:453–458.

12. Fernández-Cruz L, Herrera M, Sáenz A, Pantoja JP, Astudillo E, Sierra M. Laparoscopic pancreatic surgery in patients with neuroendocrine tumours: indications and limits. Best Pract Res Clin Endocrinol Metab. 2001. 15:161–175.

13. Singh N, Lo CY, Chan WF. Laparoscopic enucleation of a nonfunctioning neuroendocrine tumor at the head of the pancreas. JSLS. 2006. 10:259–262.

14. Pierce RA, Spitler JA, Hawkins WG, Strasberg SM, Línehan DC, Halpin VJ, et al. Outcomes analysis of laparoscopic resection of pancreatic neoplasms. Surg Endosc. 2006. 21:579–586.

15. Berends FJ, Cuesta MA, Kazemier G, van Eijck CH, de Herder WW, van Muiswinkel JM, et al. Laparoscopic detection and resection of insulinomas. Surgery. 2000. 128:386–391.

16. Aranha GV, Shoup M. Nonstandard pancreatic resections for unusual lesions. Am J Surg. 2005. 189:223–228.

17. Ayav A, Bresler L, Brunard L, Boissel P. Laparoscopic approach for solitary insulinoma: a multicenter study. Langenbecks Arch Surg. 2005. 390:134–140.

18. Giger U, Michel JM, Wiesli P, Schmid C, Krähenbühl L. Laparoscopic surgery for benign lesions of the pancreas. J Laparoendosc Adv Surg Tech. 2006. 16:452–457.