Our hospital’s project “Establishment of diagnosis and treatment system for insulinoma and its clinical application” led by President Zhao Yupei recently won second-prize National Science and Technology Progress Award 2016. The 20-year project, combining efforts from departments of basic surgery, endocrinology, radiology, nuclear medicine and gastroenterology, resulted in a surgery-centered insulinoma care system. It led to the publication of the world’s largest case study result from a single center and innovative methods that boosted qualitative detection rate to 96.3% and location diagnosis to 95%. The team took lead in formulating China’s insulinoma treatment guide and boosted the overall quality in its care.
Insulinoma is a condition subject to clinical misdiagnosis, as it is highly hidden and complicated, and qualitative and location diagnosis is difficult. Its location diagnosis is directly related to surgery type and remains the key to success. The team, based on traditional traumatic locations including DSA, ASVS and PTPC, created a series of pre-operation non-invasive location methods. It led China in applying multislice spiral computed tomography perfusion imaging (MSCTP), which boosted the location rate from 71% to above 95%; the team also led China in applying Octreotide imaging to pre-operation location, staging and recurrence monitoring of malignant insulinoma, boosting the detection rate to 85.7%. The team was also the only one in China to use Ga 68 molecular probes in PET/CT detection, creatively solving problems in qualitative diagnosis and location; besides, the team also improved and applied such technologies as endoscopic ultrasonography (EUS), ultrasound detection in micro invasive surgery and fine needle aspiration during surgery, thus cracking missed diagnosis in multiple insulinomas.
The team set up a surgery-centered comprehensive treatment system, and led China in carrying out laparoscopic surgery and robot-assisted removal, its case number remaining world’s highest in a single center. Successful surgery rate rose to 94.9%, and missed diagnosis dropped from 54.1% before 2000 to 32.6% after that. Occurrence of postoperative pancreatitis dropped from 13.3% to 1.7%; postoperative pancreatic fistula dropped from 27.4% to 14.4%, and peri-operative mortality dropped from 2.7% to 1.1%.
By Dong Lin, Cao Zhe, Duan Wenli