Surgical treatment of the diffuse form of CHI is challenging as the surgeon has to find an optimal compromise between resecting enough tissue in order to prevent persistent hypoglycemia while at the same time avoiding diabetes mellitus, exocrine pancreatic insufficiency and surgical complications causing reduced quality of life or even overall survival.

As many lesions are located deep in the pancreas, excision may be carried out more radical, with a higher chance of complications (such as pancreatic duct injury) eventually requiring partial pancreatectomy.

Furthermore, in focal CHI currently only approximately 70% of the lesions can be identified by pre-operative PET imaging so that many patients may not undergo potentially curative surgery.

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