{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T13:19:56Z","timestamp":1790169596043,"version":"4.1.0"},"reference-count":73,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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 \u00b1 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\u2013Dindo \u2265 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.<\/jats:p>","DOI":"10.3390\/cancers17233857","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T10:34:01Z","timestamp":1764758041000},"page":"3857","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Minimally Invasive Resection of Occult Insulinomas\u2014Experience from an ENETS Centre of Excellence and Review of the Literature"],"prefix":"10.3390","volume":"17","author":[{"given":"Alina S.","family":"Ritter","sequence":"first","affiliation":[{"name":"Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feline","family":"Ockenga","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3670-9504","authenticated-orcid":false,"given":"Kira C.","family":"Steinkraus","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelte","family":"Poppinga","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2971-8537","authenticated-orcid":false,"given":"Philipp H.","family":"von Kroge","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania","family":"Amin","sequence":"additional","affiliation":[{"name":"I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3348-7447","authenticated-orcid":false,"given":"Fabrice","family":"Viol","sequence":"additional","affiliation":[{"name":"I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorben W.","family":"Fr\u00fcndt","sequence":"additional","affiliation":[{"name":"I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6066-8238","authenticated-orcid":false,"given":"Felix","family":"Nickel","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thilo","family":"Hackert","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1255-6095","authenticated-orcid":false,"given":"Anna","family":"Nie\u00dfen","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,30]]},"reference":[{"key":"ref_1","unstructured":"Feingold, K.R., Anawalt, B., Blackman, M.R., Boyce, A., Chrousos, G., Corpas, E., de Herder, W.W., Dhatariya, K., Dungan, K., and Hofland, J. (2000). Insulinoma. Endotext, MDText.com, Inc. Copyright \u00a9 2000-2024, MDText.com, Inc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.amjsurg.2020.08.003","article-title":"Comparison of benign and malignant insulinoma","volume":"221","author":"Sada","year":"2021","journal-title":"Am. J. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1097\/MPA.0000000000000110","article-title":"A Systematic Review of Localization, Surgical Treatment Options, and Outcome of Insulinoma","volume":"43","author":"Mehrabi","year":"2014","journal-title":"Pancreas"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1007\/s12022-013-9262-y","article-title":"Ectopic Duodenal Insulinoma: A Very Rare and Challenging Tumor Type. Description of a Case and Review of the Literature","volume":"24","author":"Pariani","year":"2013","journal-title":"Endocr. Pathol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"R79","DOI":"10.1530\/ERC-19-0476","article-title":"Innovative imaging of insulinoma: The end of sampling? A review","volume":"27","author":"Christ","year":"2020","journal-title":"Endocr.-Relat. Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"657","DOI":"10.3748\/wjg.14.657","article-title":"Occult sporadic insulinoma: Localization and surgical strategy","volume":"14","author":"Abboud","year":"2008","journal-title":"World J. Gastroenterol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Wang, H., Ba, Y., Xing, Q., and Du, J.-L. (2018). Diagnostic value of endoscopic ultrasound for insulinoma localization: A systematic review and meta-analysis. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0206099"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1007\/s12020-016-1179-z","article-title":"Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) in insulinomas: Indications and clinical relevance in a single investigator cohort of 47 patients","volume":"56","author":"Kann","year":"2016","journal-title":"Endocrine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1007\/s40618-015-0406-4","article-title":"Preoperative localization of an insulinoma: Selective arterial calcium stimulation test performance","volume":"39","author":"Morera","year":"2015","journal-title":"J. Endocrinol. Investig."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.surg.2015.03.004","article-title":"Impact of variant pancreatic arterial anatomy and overlap in regional perfusion on the interpretation of selective arterial calcium stimulation with hepatic venous sampling for preoperative localization of occult insulinoma","volume":"158","author":"Thompson","year":"2015","journal-title":"Surgery"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1007\/s00259-003-1184-3","article-title":"Concomitant expression of several peptide receptors in neuroendocrine tumours: Molecular basis for in vivo multireceptor tumour targeting","volume":"30","author":"Reubi","year":"2003","journal-title":"Eur. J. Nucl. Med. Imaging"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2318","DOI":"10.1007\/s00259-018-4101-5","article-title":"Comparison of glucagon-like peptide-1 receptor (GLP-1R) PET\/CT, SPECT\/CT and 3T MRI for the localisation of occult insulinomas: Evaluation of diagnostic accuracy in a prospective crossover imaging study","volume":"45","author":"Antwi","year":"2018","journal-title":"Eur. J. Nucl. Med. Imaging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e13318","DOI":"10.1111\/jne.13318","article-title":"European Neuroendocrine Tumor Society 2023 guidance paper for functioning pancreatic neuroendocrine tumour syndromes","volume":"35","author":"Hofland","year":"2023","journal-title":"J. Neuroendocrinol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1111\/j.1365-2265.2009.03527.x","article-title":"What should be done in an operating room when an insulinoma cannot be found?","volume":"70","author":"Rostambeigi","year":"2009","journal-title":"Clin. Endocrinol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00423-023-02974-6","article-title":"Changes in diagnosis and operative treatment of insulinoma over two decades","volume":"408","author":"Wiese","year":"2023","journal-title":"Langenbeck\u2019s Arch. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3223","DOI":"10.1007\/s00268-018-4628-4","article-title":"Minimally Invasive Versus Open Treatment for Benign Sporadic Insulinoma Comparison of Short-Term and Long-Term Outcomes","volume":"42","author":"Belfiori","year":"2018","journal-title":"World J. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of Surgical Complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.surg.2016.11.014","article-title":"The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After","volume":"161","author":"Bassi","year":"2017","journal-title":"Surgery"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/j.surg.2007.05.005","article-title":"Delayed gastric emptying (DGE) after pancreatic surgery: A suggested definition by the International Study Group of Pancreatic Surgery (ISGPS)","volume":"142","author":"Wente","year":"2007","journal-title":"Surgery"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.surg.2007.02.001","article-title":"Postpancreatectomy hemorrhage (PPH)\u2013An International Study Group of Pancreatic Surgery (ISGPS) definition","volume":"142","author":"Wente","year":"2007","journal-title":"Surgery"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1016\/j.surg.2010.12.002","article-title":"Bile leakage after hepatobiliary and pancreatic surgery: A definition and grading of severity by the International Study Group of Liver Surgery","volume":"149","author":"Koch","year":"2011","journal-title":"Surgery"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s12022-022-09708-2","article-title":"Overview of the 2022 WHO Classification of Neuroendocrine Neoplasms","volume":"33","author":"Rindi","year":"2022","journal-title":"Endocr. Pathol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Brierley, J.D., Gospodarowicz, M.K., and Wittekind, C. (2017). TNM Classification of Malignant Tumours, John Wiley & Sons. [8th ed.].","DOI":"10.1002\/9780471420194.tnmc26.pub3"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2056","DOI":"10.1007\/s00268-020-05462-w","article-title":"Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019","volume":"44","author":"Melloul","year":"2020","journal-title":"World J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.2967\/jnumed.115.157768","article-title":"Localization of Hidden Insulinomas with 68Ga-DOTA-Exendin-4 PET\/CT: A Pilot Study","volume":"56","author":"Antwi","year":"2015","journal-title":"J. Nucl. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"luae192","DOI":"10.1210\/jcemcr\/luae192","article-title":"A Long Way to Find a Small Tumor: The Hunt for an Insulinoma","volume":"2","author":"Arjunan","year":"2024","journal-title":"Jcem Case Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1002\/ccr3.1448","article-title":"Diagnostic challenges in a patient with an occult insulinoma:68 Ga-DOTA-exendin-4 PET\/CT and 68Ga-DOTATATE PET\/CT","volume":"6","author":"Bongetti","year":"2018","journal-title":"Clin. Case Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/s00108-016-0020-3","article-title":"Okkultes Insulinom als Ursache rezidivierender Hypoglyk\u00e4mien [Recurrent hypoglycemia due to an occult insulinoma]","volume":"57","author":"Breuer","year":"2016","journal-title":"Internist"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1111\/cen.12973","article-title":"Application of Ga68-DOTA-exendin-4 PET\/CT to localize an occult insulinoma","volume":"84","author":"Cuthbertson","year":"2016","journal-title":"Clin. Endocrinol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.pan.2019.12.017","article-title":"Occult insulinoma, glucagonoma and pancreatic endocrine pseudotumour in a patient with multiple endocrine neoplasia type 1","volume":"20","author":"Erichsen","year":"2020","journal-title":"Pancreatology"},{"key":"ref_32","first-page":"9","article-title":"Severe hypoglycemia in a 14-year-old adolescent with negative imaging tests and inconclusive intra-arterial calcium stimulation test","volume":"17","year":"2024","journal-title":"Rev. Cuerpo Med. Hosp. Nac."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1007\/s11154-023-09824-2","article-title":"Ectopic insulinoma: A systematic review","volume":"24","author":"Vilarrasa","year":"2023","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e9634","DOI":"10.1002\/ccr3.9634","article-title":"The Occult Insulinoma Was Localized Using Endoscopic Ultrasound Guidance: A Case Report","volume":"13","author":"Guo","year":"2025","journal-title":"Clin. Case Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1210\/clinem\/dgad641","article-title":"Approach to the Patient: Insulinoma","volume":"109","author":"Hofland","year":"2023","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e1887","DOI":"10.1093\/milmed\/usaa100","article-title":"A Case Report: Insulinoma in a Military Pilot Detected by 68Ga-Dotatate PET\/CT","volume":"185","author":"Larose","year":"2020","journal-title":"Mil. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1080\/08998280.2019.1678338","article-title":"Use of 68Ga DOTATATE, a new molecular imaging agent, for neuroendocrine tumors","volume":"33","author":"LeBlanc","year":"2019","journal-title":"Bayl. Univ. Med Cent. Proc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1097\/RLU.0000000000001087","article-title":"68Ga-NOTA-Exendin-4 PET\/CT in Localization of an Occult Insulinoma and Appearance of Coexisting Esophageal Carcinoma","volume":"41","author":"Luo","year":"2016","journal-title":"Clin. Nucl. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1097\/RLU.0000000000001563","article-title":"68Ga-Exendin-4 PET\/CT in Evaluation of Endoscopic Ultrasound\u2013Guided Ethanol Ablation of an Insulinoma","volume":"42","author":"Luo","year":"2017","journal-title":"Clin. Nucl. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1007\/s00259-014-2946-9","article-title":"68Ga-NOTA-exendin-4 PET\/CT in detection of occult insulinoma and evaluation of physiological uptake","volume":"42","author":"Luo","year":"2014","journal-title":"Eur. J. Nucl. Med. Imaging"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1007\/s12262-022-03569-z","article-title":"Outcome of Pre-operative vs Intraoperative Localization Techniques in Insulinoma: Experience in a Tertiary Referral Center","volume":"86","author":"Mishra","year":"2022","journal-title":"Indian J. Surg."},{"key":"ref_42","first-page":"102240","article-title":"A case report on a protracted course of a hidden insulinoma","volume":"64","author":"Shah","year":"2021","journal-title":"Ann. Med. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1111\/imj.13664","article-title":"Localisation of occult extra-pancreatic insulinoma using glucagon-like peptide-1 receptor molecular imaging","volume":"48","author":"Mossman","year":"2018","journal-title":"Intern. Med. J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e2613","DOI":"10.1093\/milmed\/usae562","article-title":"Unmasking Long QT Syndrome in a Serviceman: Effects of Hypoglycemia and a Flight Duty Medical Examination","volume":"190","author":"Olatunbosun","year":"2025","journal-title":"Mil. Med."},{"key":"ref_45","first-page":"55","article-title":"Localization of Pancreatic Insulinomas with Arterial Stimulation by Calcium and Hepatic Venous Sampling-Presentation of a Single Centre Experience","volume":"12","author":"Perkov","year":"2016","journal-title":"Acta Endocrinol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12902-022-00985-w","article-title":"Occult insulinoma with treatment refractory, severe hypoglycaemia in multiple endocrine neoplasia type 1 syndrome; difficulties faced during diagnosis, localization and management; a case report","volume":"22","author":"Ranaweerage","year":"2022","journal-title":"BMC Endocr. Disord."},{"key":"ref_47","first-page":"1636","article-title":"Localizing an occult Insulinoma by Selective Calcium Arterial Stimulation Test: First ever experience and a new dimension to diagnosis in Pakistan","volume":"70","author":"Rashid","year":"2020","journal-title":"J. Pak. Med Assoc."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Sakaki, K., Murakami, T., Fujimoto, H., Shimizu, Y., Miyake, K.K., Otani, D., Otsuki, S., Shimizu, H., Nagai, K., and Nomura, T. (2025). Case Report: A case of occult insulinoma localized by [18F] FB (ePEG12)12-exendin-4 positron emission tomography with negative findings of selective arterial calcium stimulation test. Front. Endocrinol., 16.","DOI":"10.3389\/fendo.2025.1556813"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s11307-019-01372-z","article-title":"Superior Diagnostic Performance of the GLP-1 Receptor Agonist [Lys40(AhxHYNIC-[99mTc]\/EDDA)NH2]-Exendin-4 over Conventional Imaging Modalities for Localization of Insulinoma","volume":"22","author":"Senica","year":"2019","journal-title":"Mol. Imaging Biol."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Sowa-Staszczak, A., Trofimiuk-M\u00fcldner, M., Stefa\u0144ska, A., Tomaszuk, M., Buziak-Bereza, M., Gilis-Januszewska, A., Jabrocka-Hybel, A., G\u0142owa, B., Ma\u0142ecki, M., and Bednarczuk, T. (2016). 99mTc Labeled Glucagon-Like Peptide-1-Analogue (99mTc-GLP1) Scintigraphy in the Management of Patients with Occult Insulinoma. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0160714"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"234","DOI":"10.14701\/ahbps.2020.24.2.234","article-title":"Seeking the unseen: Localization and surgery for an occult sporadic insulinoma","volume":"24","author":"Subasinghe","year":"2020","journal-title":"Ann. Hepato-Biliary-Pancreat. Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1016\/j.jvir.2017.06.039","article-title":"Selective Arterial Calcium Stimulation with Hepatic Venous Sampling in Patients with Recurrent Endogenous Hyperinsulinemic Hypoglycemia and Metastatic Insulinoma: Evaluation in Five Patients","volume":"28","author":"Thompson","year":"2017","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"216","DOI":"10.3329\/bjms.v20i1.50376","article-title":"Insulinoma of Pancreatic Head Localized by Intra-Arterial Calcium Stimulation with Hepatic Venous Sampling","volume":"20","author":"Wong","year":"2021","journal-title":"Bangladesh J. Med Sci."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"4487","DOI":"10.1007\/s00259-025-07298-9","article-title":"Glucagon-like peptide-1 receptor PET\/CT with 68Ga-exendin-4 for localizing insulinoma: A real-world, single-center study","volume":"52","author":"Zhang","year":"2025","journal-title":"Eur. J. Nucl. Med. Imaging"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1159\/000268166","article-title":"Neuropsychiatric Profiles of Patients with Insulinomas","volume":"63","author":"Ding","year":"2009","journal-title":"Eur. Neurol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2020\/1030518","article-title":"Clinical Characteristics and Management of Functional Pancreatic Neuroendocrine Neoplasms: A Single Institution 20-Year Experience with 286 Patients","volume":"2020","author":"Qu","year":"2020","journal-title":"Int. J. Endocrinol."},{"key":"ref_57","first-page":"98","article-title":"Insulinoma--experience from 1950 to 1995","volume":"169","author":"Boukhman","year":"1998","journal-title":"West J Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/S2213-8587(13)70049-4","article-title":"Glucagon-like peptide-1 receptor imaging for the localisation of insulinomas: A prospective multicentre imaging study","volume":"1","author":"Christ","year":"2013","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.2967\/jnumed.110.085142","article-title":"Glucagon-Like Peptide-1 Versus Somatostatin Receptor Targeting Reveals 2 Distinct Forms of Malignant Insulinomas","volume":"52","author":"Wild","year":"2011","journal-title":"J. Nucl. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"44S","DOI":"10.2967\/jnumed.120.246009","article-title":"Glucagon-like Peptide-1 Receptor as Emerging Target: Will It Make It to the Clinic?","volume":"62","author":"Wild","year":"2021","journal-title":"J. Nucl. Med."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Dieterle, M.P., Husari, A., Prozmann, S.N., Wiethoff, H., Stenzinger, A., R\u00f6hrich, M., Pfeiffer, U., Kie\u00dfling, W.R., Engel, H., and Sourij, H. (2023). Diffuse, Adult-Onset Nesidioblastosis\/Non-Insulinoma Pancreatogenous Hypoglycemia Syndrome (NIPHS): Review of the Literature of a Rare Cause of Hyperinsulinemic Hypoglycemia. Biomedicines, 11.","DOI":"10.3390\/biomedicines11061732"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1007\/s12020-015-0633-7","article-title":"Preoperative localization of adult nesidioblastosis using 68Ga-DOTA-exendin-4-PET\/CT","volume":"50","author":"Christ","year":"2015","journal-title":"Endocrine"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"4478","DOI":"10.1007\/s00464-017-5501-5","article-title":"Is there a role for near-infrared technology in laparoscopic resection of pancreatic neuroendocrine tumors? Results of the COLPAN \u201ccolour-and-resect the pancreas\u201d study","volume":"31","author":"Paiella","year":"2017","journal-title":"Surg. Endosc."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Nie\u00dfen, A., Bechtiger, F.A., Hinz, U., Lewosinska, M., Billmann, F., Hackert, T., B\u00fcchler, M.W., and Schimmack, S. (2022). Enucleation Is a Feasible Procedure for Well-Differentiated pNEN\u2014A Matched Pair Analysis. Cancers, 14.","DOI":"10.3390\/cancers14102570"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.1016\/j.hpb.2021.04.013","article-title":"Surgical management of insulinoma over three decades","volume":"23","author":"Challine","year":"2021","journal-title":"HPB"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1097\/SLA.0000000000002979","article-title":"Minimally Invasive Versus Open Distal Pancreatectomy (LEOPARD): A Multicenter Patient-blinded Randomized Controlled Trial","volume":"269","author":"Boerma","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1097\/SLA.0000000000005075","article-title":"Outcomes After Minimally Invasive Versus Open Total Pancreatectomy: A Pan-European Propensity Score Matched Study","volume":"277","author":"Scholten","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1097\/SLA.0b013e3182a4e87c","article-title":"250 Robotic Pancreatic Resections: Safety and feasibility","volume":"258","author":"Zureikat","year":"2013","journal-title":"Ann Surg."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1016\/j.suronc.2018.06.001","article-title":"Safety and efficacy for robot-assisted versus open pancreaticoduodenectomy and distal pancreatectomy: A systematic review and meta-analysis","volume":"27","author":"Zhao","year":"2018","journal-title":"Surg. Oncol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"100864","DOI":"10.1016\/j.lanepe.2024.100864","article-title":"Robotic versus open partial pancreatoduodenectomy (EUROPA): A randomised controlled stage 2b trial","volume":"39","author":"Klotz","year":"2024","journal-title":"Lancet Reg. Heal.-Eur."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e864","DOI":"10.1097\/SLA.0000000000005160","article-title":"Perioperative and Oncological Outcomes of Robotic Versus Open Pancreaticoduodenectomy in Low-Risk Surgical Candidates: A Multicenter Propensity Score-Matched Study","volume":"277","author":"Liu","year":"2021","journal-title":"Ann. Surg."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"100673","DOI":"10.1016\/j.lanepe.2023.100673","article-title":"Minimally invasive versus open distal pancreatectomy for resectable pancreatic cancer (DIPLOMA): An international randomised non-inferiority trial","volume":"31","author":"Korrel","year":"2023","journal-title":"Lancet Reg. Heal.-Eur."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"2834","DOI":"10.1016\/j.cgh.2023.02.022","article-title":"Endoscopic Ultrasound-guided Radiofrequency Ablation Versus Surgical Resection for Treatment of Pancreatic Insulinoma","volume":"21","author":"Napoleon","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/23\/3857\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T10:52:28Z","timestamp":1764759148000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/23\/3857"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,30]]},"references-count":73,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["cancers17233857"],"URL":"https:\/\/doi.org\/10.3390\/cancers17233857","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,30]]}}}