Background/Objectives: Insulinomas are rare insulin-secreting pancreatic neuroendocrine tumours (pNETs). Preoperative tumour localisation can usually be achieved by computed tomography (CT), magnetic resonance imaging, or positron emission tomography (PET)-CT. However, cross-sectional imaging can be negative, defining an insulinoma as occult and thus hampering surgical resection.Methods: All patients who underwent minimally invasive (MI) surgery for an insulinoma at the University Medical Center Hamburg-Eppendorf since 2017 were analysed. Clinicopathological parameters and diagnostic and operative approaches were assessed. A literature search of the MI resection of occult insulinomas was conducted.Results: Of eight patients with MI-resected insulinomas, two (25%) had negative preoperative imaging. Mean tumour size was 17.2 ± 13.3 mm. Patients underwent distal pancreatectomy (DP), enucleation, and pancreatic head resection (PHR) in 62.5% (5/8), 25.0% (2/8), and 12.5% (1/8) of cases, respectively. One patient had a major postoperative complication (Clavien–Dindo ≥ 3a). Twenty-four studies reporting on 140 occult insulinomas were identified. Occult insulinomas were more frequent in females, often located in the distal pancreas and G1-differentiated. Glucagon-Like Peptide-1 Receptor/PET-CT most frequently localised the conventionally non-visible insulinomas (positive in 67/76, 88.2%). Enucleation, DP, PHR and other resections were conducted in 47/94 (50.0%), 40/94 (42.6%), 4/94 (4.3%), and 3 (3.2%) of the reported cases. MI resection was reported in 10 of 19 (52.6%) specified resections.Conclusions: Insulinomas can be undetectable in cross-sectional and functional imaging. Surgical exploration with intraoperative ultrasound should be considered when clinical presentation and biochemical findings are highly suggestive for insulinoma. Minimally invasive and parenchyma sparing resection is feasible even for occult insulinomas and should always be considered.
背景/目的：胰岛素瘤是罕见的胰岛素分泌性胰腺神经内分泌肿瘤。术前通常可通过计算机断层扫描、磁共振成像或正电子发射断层扫描-计算机断层扫描实现肿瘤定位。然而，横断面影像学检查可能呈阴性，此类胰岛素瘤被定义为隐匿性，从而阻碍手术切除。 方法：对2017年以来在汉堡-埃彭多夫大学医学中心接受胰岛素瘤微创手术的所有患者进行分析。评估了临床病理参数、诊断及手术方法，并对隐匿性胰岛素瘤的微创切除进行了文献检索。 结果：在8例接受微创切除的胰岛素瘤患者中，2例（25%）术前影像学检查呈阴性。肿瘤平均大小为17.2±13.3毫米。患者分别接受远端胰腺切除术（62.5%，5/8）、肿瘤剜除术（25.0%，2/8）和胰头切除术（12.5%，1/8）。1例患者出现严重术后并发症（Clavien-Dindo分级≥3a级）。文献检索共纳入24项研究，涉及140例隐匿性胰岛素瘤。隐匿性胰岛素瘤更常见于女性，多位于胰腺远端且为G1分化。胰高血糖素样肽-1受体/正电子发射断层扫描-计算机断层扫描对常规影像不可见胰岛素瘤的定位效果最佳（阳性率88.2%，67/76）。文献报道病例中分别有47例（50.0%）、40例（42.6%）、4例（4.3%）和3例（3.2%）接受了肿瘤剜除术、远端胰腺切除术、胰头切除术及其他切除术。在明确术式的19例中，10例（52.6%）采用微创切除。 结论：胰岛素瘤可能在横断面及功能影像学检查中无法检出。当临床表现和生化检查结果高度提示胰岛素瘤时，应考虑术中超声探查。即使对于隐匿性胰岛素瘤，微创及保留胰腺实质的切除术也是可行的，应始终予以考虑。
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