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25 November 2025, Volume 30 Issue 06 Previous Issue   

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Consensus and guideline

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Interpretation of the Asian Consensus on systemic therapy for pancreatic ductal adenocarcinoma WEN Chenlei, ZOU Siyi, LI Fanlu, ZHAN Qian, SHEN Baiyong 2025, 30 (06):  461-468.  DOI: 10.16139/j.1007-9610.2025.06.01 Abstract ( 43 )   HTML ([an error occurred while processing this directive] )   PDF (1020KB) ([an error occurred while processing this directive])   Pancreatic ductal adenocarcinoma (PDAC) is difficult to diagnose in its early stages. Most patients are diagnosed at a locally advanced or metastatic stage. Systemic therapy has become the key to improve survival. To bridge the differences in guidelines across Asian countries and address regional clinical practice needs, 14 leading experts in the Asia-Pacific region developed the “Asian Consensus on systemic therapy for pancreatic ductal adenocarcinoma” on the Delphi method. The consensus centers on 14 core recommendations (R1-R14) and proposes stratified management strategies based on disease stage. For resectable PDAC, adjuvant modified FOLFIRINOX (mFOLFIRINOX) is the preferred option, while for the patients with poor performance status gemcitabine plus capecitabine, S-1 monotherapy, and other regimens can be selected. For borderline resectable PDAC, neoadjuvant therapy is recommended, with GnP or FOLFIRINOX as the preferred regimens. For locally advanced PDAC, combination or monochemotherapy is selected based on their performance status. For metastatic PDAC, first-line options include GnP, NALIRIFOX, or mFOLFIRINOX, with second-line therapy the cross-use of gemcitabine-based and 5-FU-based regimens are emphasized. This consensus provides for the first time a comprehensive and standardized management framework for systemic therapy of PDAC in Asia, aiming to enhance regional homogeneity in clinical practice and improve patient outcomes. This article interpreted the consensus content with the goal of guiding clinical practice. References | Related Articles | Metrics

Experts forum

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Clinical experience with arterial resection during radical resection for pancreatic cancer YIN Jie, JIANG Kuirong 2025, 30 (06):  469-473.  DOI: 10.16139/j.1007-9610.2025.06.02 Abstract ( 46 )   HTML ( 1 )   PDF (922KB) ( 3 )   With advancements in surgical techniques and the application of neoadjuvant and conversion therapies, arterial resection and reconstruction offers a potential curative option for patients with locally advanced pancreatic cancer. Preoperative meticulous assessment of arterial involvement using imaging, combined with biological markers and the patient's physical status, allows for strict patient selection. Intraoperative strategies such as the “artery-first approach” and “sub-adventitial divestment” can be employed to determine the feasibility of radical resection. For arteries that cannot be preserved, procedures such as celiac axis resection, hepatic artery resection, or superior mesenteric artery resection and reconstruction may be performed depending on the site of involvement. Given the technical complexity of arterial resection and the associated high morbidity and mortality rates, this procedure should be carried out in high-volume pancreatic centers with extensive experience, and further large-scale studies are needed to validate its long-term efficacy. References | Related Articles | Metrics

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Reflections on key issues in neoadjuvant therapy for pancreatic cancer: a paradigm shift from evidence-based medicine to precision medicine KANG Xiaochao, LI Yikai, GUO Shiwei, JIN Gang 2025, 30 (06):  474-478.  DOI: 10.16139/j.1007-9610.2025.06.03 Abstract ( 41 )   HTML ( 2 )   PDF (925KB) ( 7 )   Neoadjuvant therapy for pancreatic cancer is undergoing a paradigm shift from conventional chemotherapy to precision medicine. This expert forum discussed cutting-edge issues in pancreatic cancer neoadjuvant therapy from an evidence-based perspective, incorporating the latest clinical research advances. We focused on innovative directions including immunotherapy combination strategies, liquid biopsy applications, artificial intelligence (AI)-assisted decision making, and individualized precision medicine. We proposed forward-looking concepts such as molecular subtyping-guided individualized treatment strategies, multi-omics integrated efficacy prediction models, and standardized multidisciplinary collaborative care systems. These innovative concepts will drive pancreatic cancer neoadjuvant therapy toward more precise and effective directions. References | Related Articles | Metrics

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Application progress of artificial intelligence in preoperative diagnosis of pancreatic cancer MAO Liang, QIU Yudong 2025, 30 (06):  479-482.  DOI: 10.16139/j.1007-9610.2025.06.04 Abstract ( 51 )   HTML ( 1 )   PDF (865KB) ( 5 )   Pancreatic cancer is the most challenging issue in the field of pancreatic surgery. Accurate preoperative diagnosis is the key to improving prognosis. Currently, there have been research reports on the application of artificial intelligence(AI) in the early diagnosis, differential diagnosis, and stratified diagnosis of pancreatic cancer. This article summarized the representative studies and focused on introducing their innovative thinking, modeling methods, research results, and clinical significance, demonstrating the application potential of AI in preoperative diagnosis of pancreatic cancer, with the aim of providing inspiration for subsequent research in this field. References | Related Articles | Metrics

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Anatomical classification and intraoperative management strategies of dorsal pancreatic artery in 576 standard pancreatic surgeries OU Huiyi, JIN Kaizhou, YE Longyun, WU Weiding 2025, 30 (06):  483-487.  DOI: 10.16139/j.1007-9610.2025.06.05 Abstract ( 55 )   HTML ( 1 )   PDF (4943KB) ( 5 )   Dorsal pancreatic artery (DPA) is one of the most commonly studied arteries in the pancreas. The management of DPA during pancreatic standard resection/radical surgery (pancreaticoduodenectomy, distal pancreatectomy, and total pancreatectomy) is closely related to complications such as late bleeding caused by pancreatic fistula erosion after surgery. This article collected data from patients who underwent open/minimally invasive standard pancreatic resection/radical surgery from August 2024 to July 2025, displayed different origins of DPA, and discussed the management of DPA during standard pancreatic resection/radical surgery. This article updated and improved the latest classification of DPA, and highlighted the importance of programmatic management of DPA in pancreatic surgery to reduce the risk of late postoperative bleeding. Figures and Tables | References | Related Articles | Metrics

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Technical innovation in precise enucleation of pancreatic head tumors and postoperative pancreatic fistula prevention strategies YANG Feng, XU Yecheng, FU Deliang 2025, 30 (06):  488-493.  DOI: 10.16139/j.1007-9610.2025.06.06 Abstract ( 58 )   HTML ( 13 )   PDF (2326KB) ( 10 )   Benign and low-grade malignant tumors of the pancreatic head have distinct clinicopathological features and a relatively indolent biological behavior, leading to favorable prognoses and high surgical cure rates. When indicated, enucleation enables maximal preservation of pancreatic function with minimal trauma, demonstrating considerable clinical promise. This article focused on recent technical advances in enucleation for pancreatic head tumors and postoperative pancreatic fistula (POPF) prevention strategies, offering a systematic review of current concepts and clinical practices in the field. In the context of advancing precision surgery and minimally invasive techniques, enucleation—as a pancreatic function-preserving procedure—continues to present challenges in indication selection, intraoperative technique, and perioperative management. Covered topics included preoperative multimodal imaging and three-dimensional reconstruction for tumor localization, the application of intraoperative ultrasound and fluorescence navigation, comparison and selection of surgical approaches (such as anterior, posterior, and retroperitoneal laparoscopic routes), and the advantages and limitations of minimally invasive techniques including robotic and laparoscopic surgery. Proactive strategies for POPF prevention and management were also discussed. Finally, the importance of multidisciplinary collaboration and individualized decision-making was emphasized, with the goal of improving surgical safety, reducing complications, and enhancing patient prognosis. Figures and Tables | References | Related Articles | Metrics

Original article

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Obesity significantly increases the risk of erectile dysfunction: a meta-analysis based on observational studies JI Lang, HAO Shaolong, SUN Haitao, SUN Wuqing, Ma Jihong, BAI Rixing, HAN Wei 2025, 30 (06):  494-502.  DOI: 10.16139/j.1007-9610.2025.06.07 Abstract ( 42 )   HTML ( 1 )   PDF (1865KB) ( 5 )   Objective To quantify the association between obesity and erectile dysfunction (ED) risk through a meta-analysis. Methods Following PRISMA guidelines, systematic searches of Chinese and English databases (up to March 2025) were conducted to include observational studies (cohort, cross-sectional, case-control). Adjusted effect sizes (OR and 95% CI) were extracted. Study quality was assessed using the Agency for Healthcare Research and Quality(AHRQ) scale, and a random-effects model was applied to pool effect sizes. Subgroup analyses (geographic region, obesity definitions) and sensitivity analyses were performed to validate robustness. Results Ten studies (n=230 744), including nine cross-sectional studies, were included. The meta-analysis revealed that obesity significantly increased ED risk (random-effects OR=1.80, 95% CI: 1.29-2.51), with high heterogeneity (I2=99.9%). Subgroup analyses indicated stronger associations in USA populations (OR=2.10, 95% CI: 1.23-3.60) than in Chinese populations (OR=1.16, 95% CI: 1.05-1.28). The highest effect size was observed when using BMI≥25 kg/m3 as the obesity threshold (OR=3.05, 95% CI: 2.06-4.51). Sensitivity analyses confirmed robust results (OR: 1.60-1.94 after excluding any single study). Conclusions Obesity is a critical risk factor for ED, with effect strength influenced by geographic region and obesity definitions. Interventions targeting BMI≥30 kg/m2 in Western populations and metabolic risks at BMI≥25 kg/m3 in Asian populations are recommended. Figures and Tables | References | Related Articles | Metrics

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Gasless subclavicular lateral approach: an anatomically tailored surgical technique for parathyroid surgery FENG Wenqing, GAO Haoji 2025, 30 (06):  503-508.  DOI: 10.16139/j.1007-9610.2025.06.08 Abstract ( 49 )   HTML ( 2 )   PDF (4209KB) ( 5 )   Objective To explore the safety and effectiveness of gasless subclavicular lateral approach in parathyroid surgery. Methods A retrospective comparative study was conducted to collect a total of 53 patients with primary hyperparathyroidism who underwent surgical treatment at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from November 2024 to April 2025. Among them, 20 patients underwent subclavicular lateral approach surgery (experimental group). The control group was matched 1∶1 based on criteria including gender, age, tumor size, and preoperative （parathyroid hormone, PTH） levels. Twenty patients who underwent conventional anterior cervical approach during the same period were selected for a case-control study. The surgical efficacy, postoperative incision pain, incidence of complications, and cosmetic effects between two groups were compared. Results There was no statistically significant difference (P>0.05) in operative time, intraoperative bleeding, hospitalization time, and surgical efficiency between the two groups. There was no statistically significant difference in the incidence of postoperative complications such as hoarseness, water choking, incision infection, incision hematoma, fever, and postoperative pain scores between the two groups during hospitalization (P>0.05). In the scar assessment one month after surgery, the score of the experimental group was lower than that of the control group (P<0.05). The satisfaction score of the beauty effect in the experimental group was significantly better than that in the control group (P<0.01). Conclusions Gasless subclavicular lateral approach for parathyroidectomy, as an emerging and anatomically optimized surgical technique, has good effectiveness and safety, without significantly increasing surgical risks. It can safely remove lesions without leaving surgical scars in the anterior neck, and has the advantage of good cosmetic effects. As a safe and feasible surgical method, it provides a new and ideal choice for patients undergoing parathyroid surgery. Figures and Tables | References | Related Articles | Metrics

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Characteristics of cyst fluid can predict the benign or malignant nature of intraductal papillary mucinous neoplasms WANG Jingyuan, FAN Jiayu, ZHANG Pingping, MA Hongyun, CHEN Ying, LI Gang, JIN Zhendong, JIN Gang, WANG Kaixuan 2025, 30 (06):  509-516.  DOI: 10.16139/j.1007-9610.2025.06.09 Abstract ( 73 )   HTML ( 2 )   PDF (1972KB) ( 7 )   Objective To investigate the predictive ability of cyst fluid characteristics for malignant intraductal papillary mucinous neoplasms (IPMNs). Methods We prospectively collected fresh cyst fluid from patients undergoing pancreatic resection at the Department of Hepatobiliary Pancreatic Spleen Surgery, Changhai Hospital, Shanghai, from September 2023 to December 2024, who were ultimately pathologically confirmed with IPMN. We assessed the characteristics of cyst fluid, including viscosity, clarity, and color, and explored its predictive performance for benign or malignant. Results A total of 40 patients with IPMN were included. The sensitivity of the string sign （+） for diagnosing high-grade dysplasia/ invasive carcinoma （HGD/IC） was 90.9%, specificity was 92.9%, and accuracy was 76.0%. The cyst fluid of intestinal-type IPMN often exhibited a gelatinous consistency, and there was no significant difference in the distribution of gelatinous consistency between the HGD/IC group and the low-grade dysplasia （LGD） group. There were no significant differences in CEA, glucose, and amylase levels in the cyst fluid between the HGD/IC group and the LGD group. Conclusions The characteristics of pancreatic cyst fluid, especially viscosity, can effectively predict the benign or malignant nature of IPMN. Figures and Tables | References | Related Articles | Metrics

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Clinical evaluation and management of checkpoint inhibitor pneumonitis with advanced biliary tract cancer: a report of 3 cases SUN Xueying, WU Bin, JIANG Yifei, LIAO Zhuojun, ZHAO Jinyan, ZHOU Ying, ZHANG Shulong, WANG Yan, LIU Houbao 2025, 30 (06):  517-523.  DOI: 10.16139/j.1007-9610.2025.06.10 Abstract ( 41 )   HTML ( 2 )   PDF (2388KB) ( 4 )   Objective To report cases of checkpoint inhibitor pneumonitis （CIP） in patients with advanced biliary tract cancer, aiming to provide additional approaches for the assessment, treatment, and monitoring of this condition. Methods Three patients developed oxygen desaturation and interstitial lung lesions during chemotherapy combined with immunotherapy, and were diagnosed with CIP in collaboration with the respiratory department. Antitumor therapy was discontinued in the acute phase, and glucocorticoids were administered, with regular monitoring of disease progression. During follow-up, case 1 developed lung metastasis; case 2 showed improvement; case 3 had concurrent infection and tumor progression. Results Glucocorticoids improved lung lesions and hypoxic symptoms in patients with CIP, but attention should be paid to the potential for concurrent infections and tumor progression. Conclusions Comprehensive assessment and early identification of CIP are crucial for patients with advanced biliary tract cancer. For those with recurrent symptoms after glucocorticoid therapy, timely and accurate adjustment of the treatment regimen is essential. Figures and Tables | References | Related Articles | Metrics

Review

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Advances of prevention and management for post-pancreatectomy acute pancreatitis CHEN Haoda, SHEN Baiyong 2025, 30 (06):  524-528.  DOI: 10.16139/j.1007-9610.2025.06.11 Abstract ( 70 )   HTML ( 3 )   PDF (1190KB) ( 4 )   Post-pancreatectomy acute pancreatitis (PPAP) is a common complication following pancreatic surgery, characterized primarily by early postoperative local and systemic inflammatory responses. These responses can trigger a series of subsequent complications, significantly impacting patient’s clinical outcomes. In recent years, PPAP has been recognized as a distinct postoperative complication, and the International Study Group of Pancreatic Surgery (ISGPS) has proposed standardized definitions and grading criteria for it, which required a combination of postoperative enzyme elevation, imaging features, and changes in clinical management. This has garnered widespread attention within the field of pancreatic surgery. The occurrence of PPAP is closely related to microcirculatory disturbances. Clinically, it can manifest as self-limiting inflammation and is closely associated with pancreatic fistula development. In some cases, it may progress to necrotizing pancreatitis, potentially requiring surgical intervention. Current prevention and management strategies focus on intraoperative preservation of pancreatic blood supply, perioperative use of anti-inflammatory medications, and symptomatic supportive care. However, the diagnostic criteria, pathogenesis, and comprehensive management framework for PPAP still require further research and refinement. Figures and Tables | References | Related Articles | Metrics

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Research progress on the mechanism of regulated cell death in thyroid carcinoma NIU Lingshan, ZHAO Yue, SHI Xu, YANG Zheyu, PAN Ruijun, CAI Wei 2025, 30 (06):  529-536.  DOI: 10.16139/j.1007-9610.2025.06.12 Abstract ( 61 )   HTML ([an error occurred while processing this directive] )   PDF (1254KB) ([an error occurred while processing this directive])   Thyroid carcinoma is one of the malignant tumors with rapidly increasing incidence rates. Some refractory patients face challenges from drug toxicity and resistance, urgently requiring the discovery of new therapeutic pathways to improve prognosis. Regulatory cell death（RCD）is a highly regulated orderly death mode, including apoptosis, necroptosis, pyroptosis, ferroptosis, and cuproptosis. Recent studies have found that RCD is closely associated with tumor progression, invasion, and resistance. This article systematically reviewed various death modes in thyroid cancer, including the core signaling nodes of each death pathway, and explored their specific functions in tumor progression. It also summarized potential therapeutic strategies targeting these death pathways. However, the complexity of RCD mechanisms and the sensitivity of treatments remain controversial. Future efforts should focus on screening broad-spectrum targets and developing synergistic therapies to ultimately achieve precise treatment based on cell death, thereby improving the prognosis of refractory thyroid cancer. Figures and Tables | References | Related Articles | Metrics

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Current status and prospects of minimally invasive surgery for breast cancer in China DUAN Shiyu, JIN Yiting 2025, 30 (06):  537-543.  DOI: 10.16139/j.1007-9610.2025.06.13 Abstract ( 75 )   HTML ([an error occurred while processing this directive] )   PDF (928KB) ([an error occurred while processing this directive])   This article provided a systematic review of the current application and development prospect of minimally invasive surgery for breast cancer in China. Although application of endoscopic and robotic surgical procedures remain limited in breast surgery, they have shown advantages in cosmetic outcomes and postoperative recovery across various procedures, including axillary lymph node dissection, breast-conserving surgery, mastectomy, and breast reconstruction. Nonetheless, further high-quality clinical evidence is needed to confirm their long-term oncological safety. Despite current challenges of prolonged operation time and high medical cost, minimally invasive techniques are poised to become an integral component of breast cancer surgical care with continuous refinements of technology and accumulating clinical evidence. References | Related Articles | Metrics

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Current status and reflections on immunotherapy and targeted therapy for unresectable biliary tract cancer YU Liqin, YAN Xiaoyu, WANG Puxiongzhi, WANG Wei, WANG Jian 2025, 30 (06):  544-550.  DOI: 10.16139/j.1007-9610.2025.06.14 Abstract ( 63 )   HTML ([an error occurred while processing this directive] )   PDF (939KB) ([an error occurred while processing this directive])   Biliary tract cancer (BTC) represents a group of highly malignant solid tumors with a five-year survival rate of only 10%. For patients with unresectable BTC, gemcitabine combined with cisplatin has been the conventional first-line treatment regimen. With the remarkable efficacy of immunotherapy and targeted therapy observed in other solid tumors, numerous studies have investigated their potential in unresectable BTC. This article provides an overview of the current status of targeted and immunotherapeutic approaches for unresectable BTC, with a focus on research advancements in immune checkpoint inhibitor (ICI) and targeted agents against fibroblast growth factor receptor(FGFR), isocitrate dehydrogenase(IDH), and human epidermal growth factor receptor 2(HER2), as well as future trends in immunotherapy and targeted therapy, aiming to contribute to the development of more effective treatment strategies. References | Related Articles | Metrics