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25 January 2024, Volume 29 Issue 01 Previous Issue   
Experts forum
Research and guidelines interpretation of neoadjuvant therapy for resectable pancreatic cancer, promising or limited?
ZHANG Taiping, WENG Guihu, LIU Yueze
2024, 29 (01):  1-4.  DOI: 10.16139/j.1007-9610.2024.01.01
Abstract ( 37 )   HTML ( 11 )   PDF (829KB) ( 10 )  

As a systemic disease, pancreatic cancer is highly malignant and has a high rate of recurrence and metastasis, which makes it particularly difficult in diagnosis, treatment and management. In recent years, with the concept of neoadjuvant therapy deeply rooted in the hearts of the people, the treatment of pancreatic cancer has increasingly emphasized the development of comprehensive and individualized treatment schemes in the whole process and multi-dimensional management of pancreatic cancer patients. However, there still remain many controversies about the application of neoadjuvant therapy for resectable pancreatic cancer. This review intended to discuss the hot topics and related controversies in the implementation of neoadjuvant therapy for patients with resectable pancreatic cancer based on domestic and foreign guidelines and the latest research progress, which may vastly promote the standardized application of neoadjuvant therapy for resectable pancreatic cancer.

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The future directions of artificial intelligence in the biological benefit-dominated diagnosis and treatment of pancreatic cancer
QI Zhong, XING Ying, CHENG Shi
2024, 29 (01):  5-9.  DOI: 10.16139/j.1007-9610.2024.01.02
Abstract ( 27 )   HTML ( 2 )   PDF (777KB) ( 8 )  

Pancreatic cancer is a high malignant tumor with insidious onset, early metastasis, and extremely poor prognosis. How to improve the early diagnosis and the prognosis of the patients is the current research focus. Although traditional surgical resection may improve the prognosis of some patients, the long-term effect is still poor. Biological benefit is the new mode of pancreatic cancer treatment, and it is crucial to do the whole process monitoring, precisely make the treatment plan and predict the effect under this mode. Artificial intelligence technology, with its powerful data processing and image recognition functions and high learning efficiency, can help to build relatively perfect prediction models with the cooperation of multidisciplinary experts, assist clinicians to make optimal plans, and make the pancreatic cancer patients benefit from precision medicine and individualized therapy.

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Consensus and guidelines
Interpretation of 2023 2nd NCCN clinical practice guidelines in oncology-pancreatic adenocarcinoma
CHEN Jiahao, JIANG Chongyi
2024, 29 (01):  10-13.  DOI: 10.16139/j.1007-9610.2024.01.03
Abstract ( 92 )   HTML ( 2 )   PDF (860KB) ( 31 )  

Pancreatic adenocarcinoma, a severe digestive malignancy, is characterized by its poor prognosis. The National Comprehensive Cancer Network (NCCN) persistently refines its guidelines, integrating cutting-edge evidence-based medical insights to standardize the diagnostic and therapeutic strategies of pancreatic adenocarcinoma. The NCCN clinical practice guidelines in oncology-pancreatic adenocarcinoma were updated twice on May 4 and June 19, 2023, respectively. Compared to the 2022 predecessor, these two updates placed a particular emphasis on immunotherapy/targeted therapy, the introduction of NALIRIFOX regimen, and supplementary treatment protocols for patients with intermediate performance status. This article provided an interpretation of the latest updates to the NCCN clinical practice guidelines in oncology-pancreatic adenocarcinoma, integrating relevant evidence-based medical findings.

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Chinese interpretation of European Neuroendocrine Tumour Society 2023 guidance for nonfunctioning pancreatic neuroendocrine tumours
HAN Liang, LIU Haonan, WU Zheng
2024, 29 (01):  14-26.  DOI: 10.16139/j.1007-9610.2024.01.04
Abstract ( 34 )   HTML ( 2 )   PDF (962KB) ( 7 )  

This ENETS guidance for well-differentiated nonfunctioning pancreatic neuroendocrine tumours (NF-Pan-NET), which published on Journal of Neuroendocrinology (2023), has been developed by a multidisciplinary working group, and provides up-to-date and practical advice on the management of these tumours. In this guideline, the authors discussed 10 troublesome questions about clinical practice, and summarized the extensive experience of their centers treating patients with NF-Pan-NET, and suggested that multidisciplinary participation is an essential part of NF-Pan-NET diagnosis and treatment. This paper aims to interpret the key contents of the guidelines in order to provide standardized clinical diagnosis and treatment procedures in NF-Pan-NET.

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Original article
Clinical value analysis of simple resection of pancreatic solid pseudopapillary tumor
GUO Yujie, TANG Ying, GU Jichun, YANG Feng, LIU Huaye, JIN Chen, FU Deliang, Li Ji
2024, 29 (01):  27-33.  DOI: 10.16139/j.1007-9610.2024.01.05
Abstract ( 31 )   HTML ( 1 )   PDF (2596KB) ( 11 )  

Objective To explore the clinical application value of simple resection in the treatment of pancreatic solid pseudopapillary tumor(SPT). Methods Retrospective analysis of clinical and follow-up data of pancreatic SPT patients who underwent simple pancreatectomy and conventional pancreatectomy from January 2015 to December 2022 in the pancreatic cystic tumor database of Huashan Hospital, Fudan University. A total of 87 patients with pancreatic SPT, including 14 cases underwent simple resection and 73 cases underwent conventional resection, were included. The average age was (36.2±11.7) years old, and females accounting for 87.4%. Results The accuracy of preoperative imaging diagnosis reached 88.5%. Simple resection had a significant advantage over conventional resection in terms of surgical time [(138.3±56.4) min vs. (241.2±89.2) min, P<0.05]. Simple resection was not inferior to conventional resection in terms of common postoperative complications. Out of 87 cases, only 3 patients in conventional resection group experienced postoperative recurrence and metastasis, and all recurrent patients were still alive. There was no statistically significant difference in postoperative pancreatic endocrine and exocrine dysfunction, and quality of life between simple resection group and conventional resection group. Conclusions Simple resection of pancreatic SPT is reasonable and feasible, but the risks in actual clinical work cannot be ignored. Therefore, selective simple resection of SPT has certain clinical application value.

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Application and evaluation of modified “double U-stitch pancreaticojejunostomy” in pancreaticoduodenectomy
HUA Jie, SHI Si, MENG Qingcai, XU Hang, LIU Jiang, LIANG Chen, WANG Wei
2024, 29 (01):  34-39.  DOI: 10.16139/j.1007-9610.2024.01.06
Abstract ( 26 )   HTML ( 2 )   PDF (1564KB) ( 7 )  

Objective To evaluate the efficacy of double U-stitch and modified “double U-stitch pancreaticojejunostomy” in pancreaticoduodenectomy. Methods We retrospectively analyzed the clinical information of 150 patients who underwent pancreaticoduodenectomy between January 2022 and September 2023 in Wang Wei’s team in department of pancreatic surgery, Fudan University Shanghai Cancer Center. The patients were divided into two groups according to the pancreaticojejunostomy method: the double U-stitch 1.0 group (70 cases before modification) and the double U-stitch 2.0 group (80 cases after modification). The postoperative complications of the two groups were compared. Results The overall postoperative complications were significantly lower in the double U-stitch 2.0 group as compared with the double U-stitch 1.0 group (13.8% vs. 38.6%, P=0.001). The incidence of clinically relevant pancreatic fistula was 18.6% in the double U-stitch 1.0 group, while this was significantly decreased in the double U-stitch 2.0 group (6.3%) (P=0.021). Postoperative extraluminal hemorrhage occurred in 5 patients in the double U-stitch 1.0 group, while in the double U-stitch 2.0 group, only one patient experienced postoperative intraluminal hemorrhage, the difference was statistically significant between two groups (P=0.007). The median postoperative length of hospital stay was significantly shorter in the double U-stitch 2.0 group than that in the double U-stitch 1.0 group (11 d vs. 14 d, P=0.001). Conclusions The modified “double U-stitch pancreaticojejunostomy” can significantly reduce the incidence of clinically relevant pancreatic fistula and other relevant severe complications, which helps improve the safety of the procedure.

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Construction of a prognostic Nomogram for patients with incidental gallbladder cancer
MO Jiantao, CAO Ruiqi, REN Jiaqiang, GENG Zhimin, WU Zheng, CHENG Yali
2024, 29 (01):  40-45.  DOI: 10.16139/j.1007-9610.2024.01.07
Abstract ( 26 )   HTML ( 4 )   PDF (939KB) ( 14 )  

Objective To construct and validate an effective prognostic nomogram for the patients with incidental gallbladder cancer(IGBC). Methods The clinical data of 161 patients with IGBC requiring radical surgery admitted to the First Affiliated Hospital of Xi’an Jiaotong University from May 2011 to October 2022 was analyzed retrospectively. COX proportional risk regression model was used to screen for influencing factors on overall survival(OS) of IGBC. Nomogram was constructed based on independent influencing factors that affected the prognosis of IGBC patients. The concordance index(C-index) and calibration curve were used to validate the performance of the model. Receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA) were used to validate the predictive accuracy and net benefit of the plotted column chart. Results Univariate COX regression analysis suggested that age, T stage, N stage, M stage, preoperative carcinoembryonic antigen(CEA), preoperative carbohydrate antigen19-9(CA19-9), preoperative red blood cell volume distribution on width coefficient of variation(RDW-CV), treatment method, and recurrence and metastasis were risk factors which affected the long-term survival of IGBC patients after radical surgery. Multivariate COX regression analysis suggested that T stage, N stage, preoperative CA19-9, preoperative RDW-CV, preoperative AST, treatment methods, and recurrence and metastasis were independent risk factors which affected the prognosis of IGBC patients. The C-index of the constructed prognostic model was 0.872. The calibration plot demonstrated good performance of the Nomogram. ROC curve analysis showed an area under the curve of 0.869, confirming a high sensitivity and specificity. A high net benefit was proven by DCA. Conclusions The constructed Nomogram can accurately and intuitively predict the survival probability of IGBC patients after radical surgery.

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Nomogram construction based on SEER and survival prediction of pancreatic cancer patients
LU Zhongxiao, TANG Jie, HUANG Wenhai
2024, 29 (01):  46-53.  DOI: 10.16139/j.1007-9610.2024.01.08
Abstract ( 37 )   HTML ( 10 )   PDF (1164KB) ( 9 )  

Objective To analyze the independent factors affecting the prognosis of pancreatic cancer and construct a prediction model based on surveillance, epidemiology, and end results (SEER) database. Methods The clinical data of 7 801 American pancreatic cancer patients from 2010 to 2015 were obtained from SEER database. They were randomly divided into training group and validation group in a ratio of 7:3. The nomogram was constructed after multivariate COX regression analysis of clinical variables in the training group. The accuracy of the model was verified by receiver operating characteristic(ROC) curve and calibration curve. Results Age, primary-site, grade, T-stage, N-stage, M-stage,surgery, radiotherapy and chemotherapy were related to the prognosis of the patients with pancreatic cancer. The area under curve(AUC) of overall survival(OS) ROC curve of 3- and 5-year were 0.90 and 0.91 respectively. The AUC of cancer specific survival(CSS) ROC curve were 0.91 and 0.91 respectively. The calibration curve showed a good consistency between the observed and predicted values. The selected clinical variables did have an impact on the prognosis of the patients with pancreatic cancer. Conclusions The model had good prediction accuracy and was helpful for clinical decision-making and personalized treatment of the patients with pancreatic cancer.

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Bedside ultrasound diagnosis and risk factors of early thromboembolism after pancreaticoduodenectomy with vein reconstruction
WANG Meiwen, FU Ningzhen, WANG Weishen, REN Xinping
2024, 29 (01):  54-60.  DOI: 10.16139/j.1007-9610.2024.01.009
Abstract ( 22 )   HTML ( 1 )   PDF (3506KB) ( 3 )  

Objective To investigate the risk factors of early thromboembolism after pancreaticoduodenectomy with vein reconstruction. Methods The results of bedside ultrasonography and clinical data of 90 patients from Ruijin Hospital, Shanghai Jiao Tong University School of Medicine who underwent pancreaticoduodenectomy with vein reconstruction within 7 days after operation between Janurary 2018 and September 2021 were analyzed retrospectively. According to the results of bedside ultrasound examination of the patency of portal vein, the postoperative patients were divided into portal vein patency group and portal vein embolization group. The hemodynamic differences of bedside ultrasound and the influencing factors of postoperative portal vein thromboembolism were compared. Results Among 90 patients underwent bedside ultrasound, 8 patients had portal vein thromboembolism after pancreaticoduodenectomy with vein reconstruction, and the incidence rate was 8.89%. Bedside ultrasound showed that the velocity and flow of portal vein in patients with portal vein thromboembolism decreased significantly (P<0.001). Among the perioperative related risk factors, there was a statistically significant difference in the smoking history and alcohol abuse history between the portal vein patency group and portal vein thromboembolism group. Further, previous smoking history was an independent risk factor for portal vein thromboembolism (P=0.003). The outcomes showed that the pancreaticoduodenectomy with vein reconstruction was safe and feasible, however early portal vein thromboembolism with severe complications indicated a poor prognosis. Conclusions The history of smoking and alcohol abuse are the high risk factors of portal vein thromboembolism after pancreaticoduodenectomy with vein reconstruction, which should be prevented by preoperative education. Bedside ultrasound can effectively and safely evaluate the patency of portal vein after pancreaticoduodenectomy with vein reconstruction, which contributes to early clinical intervention.

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Review
Progress of magnetic iron oxide nanoparticles in targeted diagnosis and treatment of pancreatic cancer
REN Jiaqiang, WU Shuai, MO Jiantao, ZHOU Cancan, HAN Liang, WU Zheng
2024, 29 (01):  61-66.  DOI: 10.16139/j.1007-9610.2024.01.10
Abstract ( 54 )   HTML ( 2 )   PDF (799KB) ( 11 )  

Pancreatic cancer has a very poor prognosis. Early diagnosis and treatment are especially critical for improving its prognosis. Nanotechnology has been widely used in the diagnosis and treatment of pancreatic cancer. Relying on the unique physicochemical properties of nanoparticles and their rich surface modifications, effective enrichment of tumor sites can be achieved. Magnetic iron oxide nanoparticles (MIONPs) is one of the commonly used nanomaterials in the diagnosis and treatment of pancreatic cancer, and has good biocompatibility. Through special surface modification, it can be used in targeted diagnosis and treatment of pancreatic cancer. MIONPs can be used as a contrast agent for MRI, and by modifying the surface, they also can be used in targeted imaging of pancreatic cancer. And they can also be modified as a drug delivery system to achieve targeted delivery of drugs and improve therapeutic effects. However, the application of MIONPs in pancreatic cancer diagnosis and treatment still faces some challenges, such as nanotoxicity and cost issues. With the development of technology, MIONPs are expected to play an important role in the personalized diagnosis and treatment of pancreatic cancer.

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Progress in pathological diagnosis of intraductal papillary mucinous neoplasm of the pancreas
WANG Ting, WANG Chaofu, YUAN Fei
2024, 29 (01):  67-73.  DOI: 10.16139/j.1007-9610.2024.01.11
Abstract ( 41 )   HTML ( 2 )   PDF (11011KB) ( 6 )  

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is an important precancerous lesion to pancreatic ductal adenocarcinoma. Clinical decisions in the diagnosis and treatment of IPMN are foremost based on a profound understanding of the related pathology of IPMN. Systematic literature reviews were conducted around four aspects of macroscopic examination, microscopic examination, molecular detection and differential diagnosis of IPMN. This review provided updated perspectives on gross types, histological grades and differentiation subtypes, the composition pattern and histological classification of IPMN with invasive carcinoma, the molecular research of IPMN and important differential diagnosis. This analysis confirms the heterogeneity and heterochronous in IPMN, laying the foundation for finding new method to help clinicians developing appropriate diagnosis and treatment plans.

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Advantages and advances in neoadjuvant therapy of pancreatic cancer
HU Binwei, SHEN Baiyong
2024, 29 (01):  74-80.  DOI: 10.16139/j.1007-9610.2024.01.12
Abstract ( 42 )   HTML ( 2 )   PDF (811KB) ( 9 )  

Due to the characteristics of the insidious onset, difficult early diagnosis and high malignancy of pancrea-tic cancer, only a minority of patients still have the chance of surgical resection at the time of diagnosis. In recent years, chemotherapy-based preoperative neoadjuvant therapy has been increasingly applied to pancreatic cancer without distant metastases to help achieve tumor downstaging, increase R0 resection rate and improve patient survival. A large number of clinical trials have proven the advantages of neoadjuvant therapy for pancreatic cancer, but there are still many issues to be gradually addressed by further research to reach a consensus.

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Application of pylorus-preserving gastrectomy in surgical treatment for early gastric cancer and interpretation of guidelines and consensus
YU Suyue, LU Aiguo
2024, 29 (01):  81-86.  DOI: 10.16139/j.1007-9610.2024.01.13
Abstract ( 27 )   HTML ( 1 )   PDF (873KB) ( 6 )  

Endoscopic resection (ER) and laparoscopic surgery are the main methods for treatment of early gastric cancer (EGC). Radical gastrectomy(RG) and lymph node dissection are required for the patients who don’t meet the indications of ER, but it may cause postoperative stomach dysfunction and reduce quality of life (QOL). Pylorus-preserving gastrectomy (PPG) is one of the function-preserving gastrectomy for EGC. The short-term complications of PPG are equal to that of RG and it is also beneficial to long-term nutritional status and QOL. The 5-year survival rate of PPG is similar to that of distal subtotal gastrectomy (DSG) according to a retrospective study of the matched cohort. But delayed gastric emptying (DGE) is a common problem in the short and long term after PPG. The limited lymph node dissection of PPG makes its application not widely promoted. Sentinel node navigation surgery (SNNS) may provide more personalized and minimally invasive surgery, in order to preserve the gastric function to the maximum extent.

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Progress in the treatment of colonic diverticular diseases
KONG Lei, YANG Huali
2024, 29 (01):  87-92.  DOI: 10.16139/j.1007-9610.2024.01.14
Abstract ( 33 )   HTML ( 1 )   PDF (881KB) ( 7 )  

The incidence of colonic diverticular disease is increasing significantly and is showing a trend of youthfulness. The treatment of colonic diverticulum disease mainly involves drugs, including antibiotics, rifaximin, and mesalazine. In addition, probiotics and dietary fiber are believed to have a positive impact on the treatment of diverticular diseases. When it progresses to acute complicated diverticulitis, surgical treatment becomes a necessary means. Up to now, our country has not formulated standards and guidelines of the diagnosis and treatment for colonic diverticulitis.

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