Magliozzo M, Tumminia A, Arpi M L, Deiana E, Guglielmo M, Giannone G, Frasca F, Gullo D
Endocrine Unit, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy.
Surgical Oncology Unit, Mediterranean Institute of Oncology, Viagrande, Catania, Italy.
J Endocrinol Invest. 2025 Mar;48(3):777-781. doi: 10.1007/s40618-024-02472-6. Epub 2024 Oct 14.
Insulinomas represent the most common functional pancreatic neuroendocrine tumors. Following preoperative localization, surgical excision is the curative treatment. It may be difficult to confirm a complete resection of insulinoma. We used intermittently scanned continuous glucose monitoring (isCGM) to record the fluctuation of interstitial glucose throughout surgery to help verify the tumor's complete surgical excision.
In five individuals with insulinoma undergoing laparoscopic surgery we used the isCGM system (Freestyle Libre 2 Abbott) during tumor removal in order for the surgeon to understand "in real-time" the extent of tumor removal.
Two patients received no preoperative treatment, while three patients received medical treatment with either lanreotide (2 patients) or diazoxide (1 patient). In the non-treated patients, following tumor resection, there was a rapid interstitial glucose increase along with stabilized glucose levels thoroughly documented by intraoperative isCGM. Lanreotide treatment, on the other hand, resulted in only a minor increase in interstitial glucose. Finally, diazoxide-treated patients had a response that was intermediate between lanreotide-treated and non-treated patients.
Our findings suggest that isCGM is a useful tool to monitor the outcome of surgery during pancreatic insulinoma excision, assisting the surgical team in successfully removing the tumor. Despite the limited sample size, the results are promising, and, if validated in larger studies, they make us believe that the use of CGM systems has a definite benefit for becoming a standard in the surgical treatment of insulinomas.
胰岛素瘤是最常见的功能性胰腺神经内分泌肿瘤。术前定位后，手术切除是根治性治疗方法。确认胰岛素瘤是否完全切除可能存在困难。我们使用间歇扫描式连续血糖监测（isCGM）来记录手术过程中间质葡萄糖的波动情况，以帮助验证肿瘤是否已被完全手术切除。
在5例接受腹腔镜手术的胰岛素瘤患者中，我们在切除肿瘤期间使用了isCGM系统（雅培Freestyle Libre 2），以便外科医生“实时”了解肿瘤切除的程度。
2例患者未接受术前治疗，3例患者接受了药物治疗，其中2例使用兰瑞肽，1例使用二氮嗪。在未治疗的患者中，肿瘤切除后，间质葡萄糖迅速升高，术中isCGM充分记录了血糖水平的稳定情况。另一方面，兰瑞肽治疗仅导致间质葡萄糖略有升高。最后，二氮嗪治疗的患者的反应介于兰瑞肽治疗和未治疗的患者之间。
我们的研究结果表明，isCGM是监测胰腺胰岛素瘤切除手术结果的有用工具，有助于手术团队成功切除肿瘤。尽管样本量有限，但结果很有前景，如果在更大规模的研究中得到验证，我们相信使用CGM系统对于成为胰岛素瘤手术治疗的标准方法具有明确的益处。
