{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T18:29:02Z","timestamp":1793298542734,"version":"4.5.0"},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2005,5,12]],"date-time":"2005-05-12T00:00:00Z","timestamp":1115856000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2005,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The rarity of malignant insulinoma limits reports on therapeutic strategies and outcome. The treatment and follow\u2010up of 10 patients, all presenting an insulinoma with metastatic disease of the liver and newly diagnosed between 1992 and 2002, is reported. Pancreatic surgery with successful removal of the primary tumor preferentially located in the tail was performed in 7 women and 3\u00a0men, median age 55 years (range 36\u201382 years). If appropriate, 5 patients underwent additional hepatic surgery and lymph node resections. Liver metastases as the major cause of postoperatively persistent hypoglycemia were subsequently treated by repeated transarterial hepatic chemoembolization and chemoperfusion protocols using high\u2010dose transhepatic streptozocin perfusions (3\u20134 g per session). The current median survival time for all 10 patients is 2.6 years (range: 1.6\u20139.7 years). Six patients are currently alive with a median survival of 3.7 years (1.7\u20139.7 years), five of them with stable disease and free of hypoglycemia. Four patients died after a median survival of 1.8 years (range: 1.6\u20137.5 years) from complications of unmanageable hypoglycemia. It is concluded that the necessity to treat debiliating and life\u2010threatening hypoglycemia in metastatic malignant insulinoma warrants the option of radical endocrine surgery in combination with extended and repeated postoperative chemoembolization of liver metastases.<\/jats:p>","DOI":"10.1007\/s00268-005-7743-y","type":"journal-article","created":{"date-parts":[[2005,5,5]],"date-time":"2005-05-05T13:11:35Z","timestamp":1115298695000},"page":"789-793","source":"Crossref","is-referenced-by-count":53,"title":["Malignant Metastatic Insulinoma\u2014Postoperative Treatment and Follow\u2010up"],"prefix":"10.1002","volume":"29","author":[{"given":"Achim","family":"Starke","sequence":"first","affiliation":[{"name":"Insulinoma &amp; GEP\u2010Tumor Center, Department of Internal Medicine Heinrich\u2010Heine\u2010University Moorenstrasse 5 40225 D\u00fcsseldorf Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiane","family":"Saddig","sequence":"additional","affiliation":[{"name":"Insulinoma &amp; GEP\u2010Tumor Center, Department of Internal Medicine Heinrich\u2010Heine\u2010University Moorenstrasse 5 40225 D\u00fcsseldorf Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lothar","family":"Mansfeld","sequence":"additional","affiliation":[{"name":"Insulinoma &amp; GEP\u2010Tumor Center, Department of Radiology &amp; Nuclear Medicine Lukaskrankenhaus Preussenstrasse 84 41464 Neuss Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Koester","sequence":"additional","affiliation":[{"name":"Insulinoma &amp; GEP\u2010Tumor Center, Department of Radiology &amp; Nuclear Medicine Lukaskrankenhaus Preussenstrasse 84 41464 Neuss Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyrus","family":"Tschahargane","sequence":"additional","affiliation":[{"name":"Insulinoma &amp; GEP\u2010Tumor Center, Department of Pathology Lukaskrankenhaus Preussensttasse 84 41464 Neuss Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Czygan","sequence":"additional","affiliation":[{"name":"Insulinoma &amp; GEP\u2010Tumor Center, Department of Internal Medicine, Gastroenterology, &amp; Oncology Lukaskrankenhaus Preussenstrasse 84 41464 Neuss Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Goretzki","sequence":"additional","affiliation":[{"name":"Insulinoma &amp; GEP\u2010Tumor Center, Department of Abdominal &amp; Endocrine Surgery Lukaskrankenhaus Preussenstrasse 84 41464 Neuss Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2005,5,12]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(12)62083-7"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6109(16)46638-7"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/0011-3840(94)90079-5"},{"key":"e_1_2_6_5_2","first-page":"1196","article-title":"Reoperative insulinomas, 1927 to 1992: an institutional experience","volume":"114","author":"Thompson GB","year":"1993","journal-title":"Surgery"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/jso.2930390413"},{"key":"e_1_2_6_7_2","first-page":"983","article-title":"Malignant insulinoma","volume":"50","author":"Saravu K","year":"2002","journal-title":"J. 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