Abstract:Objective: To investigate the value of application of sleeve anastomosis with single-layer continuous prolene suture in pancreaticojejunostomy. Methods: Using a prospective randomized design, 124 patients scheduled to undergo pancreaticoduodenectomy (PD) from August 2009 to March 2014 were divided into three groups, according to different pancreaticojejunostomy methods that included the conventional end-to-end or end-to-side invagination anastomosis (invagination anastomosis group), mucosa-to-mucosa anastomosis of the pancreatic duct to the jejunum (mucosa-to-mucosa anastomosis group) and sleeve anastomosis with single-layer continuous prolene suture (sleeve anastomosis group). The incidence of pancreatic fistula and other surgical variables among the three groups were compared. Results: The operative time for pancreaticojejunostomy in sleeve anastomosis group was significantly shortened compared with invagination anastomosis group or mucosa-to-mucosa anastomosis group (both P<0.05); the incidence of pancreatic fistula in the entire group was 18.5% (23/124), which in sleeve anastomosis group (4.8%) was significantly lower than that in invagination anastomosis group (29.3%) or mucosa-to-mucosa anastomosis group (22.0%) (both P<0.05); There was no significant difference in incidences of other complications (all P>0.05). Intergroup comparison after stratification by pancreatic duct size and pancreatic texture showed that the incidence of pancreatic fistula in those with pancreatic duct diameter less than 3 mm in sleeve anastomosis group (7.1%) was significantly lower than that in mucosa-to-mucosa anastomosis group (50.0%); the incidence of pancreatic fistula in those with soft pancreatic texture in sleeve anastomosis group (11.8%) was significantly lower than that in either invagination anastomosis group (53.3%) or mucosa-to-mucosa anastomosis group (53.8%) (both P<0.05). Intragroup comparison after stratification by pancreatic duct size and pancreatic texture showed that the incidence of pancreatic fistula in firm pancreatic texture subgroup (15.4%) was significantly lower than that in soft pancreatic texture subgroup (53.3%) in invagination anastomosis group (P<0.05); incidence of pancreatic fistula in large pancreatic duct subgroup (7.4%) was significantly lower than that in small pancreatic duct subgroup (50.0%), and in firm pancreatic texture subgroup (7.1%) was significantly lower than that in soft pancreatic texture subgroup (53.8%) in mucosa-to-mucosa anastomosis group (both P<0.05); there was no significant difference between either subgroups of sleeve anastomosis group (both P>0.05). Conclusion: Sleeve anastomosis with single-layer continuous prolene suture is a safe and convenient procedure, and can reduce the incidence of post-PD pancreatic fistula, especially for those with pancreatic duct diameter less than 3 mm, or soft pancreatic texture.

Abstract:Objective: To systematically evaluate the safety and efficacy of pancreaticogastrostomy (PG) and pancreaticojejunostomy (PJ) for pancreatico-digestive anastomosis after pancreaticoduodenectomy (PD). Methods: The prospective randomized controlled trials concerning application of PG and PJ in PD were collected by searching available national and international databases. Data were extracted by two independent reviewers, and the methodological quality of the included studies was evaluated according to the Cochrane handbook 5.1. Meta-analysis was performed using Manager 5.2 software. Results: A total of 7 studies were included involving 1 121 patients, with 562 cases in PG group and 559 cases in PJ group. Meta-analysis indicated that PG group was superior to PJ group with regard to the incidence of pancreatic fistula (OR=0.60, 95% CI=0.44–0.82, P=0.001), biliary fistula (OR=0.42, 95% CI=0.18–0.93, P=0.03) and intra-abdominal collection (OR=0.50, 95% CI=0.34–0.74, P=0.0005), while there was no significant difference between the two groups in respect to the incidence of delayed gastric emptying (OR=0.98, 95% CI=0.53–1.82, P=0.95) and postoperative intra-abdominal hemorrhage (OR=1.29, 95% CI=0.95–1.96, P=0.24), as well as the reoperation rate (OR=0.96, 95% CI=0.61–1.52, P=0.87) and mortality (OR=0.82, 95% CI=0.43–1.58, P=0.56). Conclusion: PG is superior to PJ in reducing the incidence of pancreatic fistula, biliary fistula and intra-abdominal collection, however, the safety and long-term efficacy of the two procedures still need further verification.

Abstract:Objective: To investigate the risk factors for occurrence of pancreatic fistula (PF) after pancreaticoduodenectomy (PD), so as to provide reference for prevention of PF after PD in clinical practice. Methods: The clinical data of 122 patients undergoing PD in Cancer Hospital affiliated to Xinjiang Medical University from January 2010 to march 2014 were reviewed. Fourteen factors potentially affecting the occurrence of PF were determined by univariate and multivariate Logistic regression analysis. Results: The incidence of PF in the whole group was 13.9% (17/122). Univariate analysis showed that history of upper abdominal surgery (P=0.024), preoperative bilirubin level (P=0.003), intraoperative blood loss (P=0.023), postoperative hemoglobin level (P=0.021), postoperative albumin level (P=0.046), and pancreatic duct diameter (P=0.007) were significantly associated with PF after PD. Multivariate analysis results demonstrated that the history of abdominal surgery, pancreatic duct diameter less than 3 mm, and postoperative hemoglobin level less than 90 g/L were independent risk factors for the occurrence of PF after PD (OR=4.308, 5.052, 3.958, all P<0.05). Conclusion: For PD patients with history of upper abdominal surgery, or with pancreatic duct diameter less than 3 mm or postoperative hemoglobin level less than 90 g/L, appropriate measures should be taken to reduce the incidence of PF after PD.

Abstract:Objective: To investigate the surgical technique and measures for prevention of postoperative pancreatic fistula in dealing with intrapancreatic choledochal cyst in adults. Methods: The clinical data of 41 patients with intrapancreatic choledochal cyst admitted from January 2006 to December 2013 were reviewed. The surgical method and technique as well as the causes for pancreatic fistula were analyzed. Results: With complete exposure of the intrapancreatic choledochal cyst after isolation of the head of the pancreas and the second and third portion of the duodenum through Kocher’s incision, 38 patients underwent cyst excision or treatment by mucosal stripping or cauterization of the cyst, and 3 patients were subjected to pancreaticoduodenectomy. All patients were discharged from hospital after recovery and no surgical death occurred. Portal vein injury occurred in one patient (2.4%) during surgery, and bile leakage occurred in one patient (2.4%), pancreatic fistula occurred in 4 patients (9.8%) following continuous suture of the bile duct stump and wound infection occurred in 5 patients (12.2%) after surgery. During follow-up for 6 months to 8 years, fever and chills occurred in 3 cases within 3 months postoperatively, one case died of tumor recurrence and two cases died of cerebral hemorrhage, while no postoperative abdominal pain, fever or recurrence of jaundice was noted in any of the other patients. The postoperative pathology revealed that in the 41 cases of intrapancreatic choledochal cyst, one case was complicated with myxopapilloma, 3 cases with mucinous adenocarcinoma, and 2 cases with adenocarcinoma. Conclusion: The procedure for intrapancreatic choledochal cyst is relatively complicated, so cyst excision or treatment by mucosal stripping or cauterization should be properly selected under the condition of adequate isolation of the head of the pancreas and the second and third portion of the duodenum. Appropriate closure of the common bile duct stump and avoidance of injury of the pancreatic duct are effective measures for prevention of pancreatic fistula.

Abstract:Objective: To investigate influential factors for early diagnosis, estimation of resectability and prognosis of pancreatic cancer. Methods: The clinical data of 185 patients with pancreatic cancer admitted from March 2011 to March 2014 were reviewed. The efficiencies of various imaging examinations in estimation of resectability were evaluated by comparing the surgical results, and the prognostic factors were also analyzed. Results: Of the entire group of patients, 103 cases were male and 82 were female with an average age of (58.87±10.59) years; the main clinical symptoms were abdominal pain, abdominal distention and jaundice; 74 cases underwent surgical treatment and 111 cases did not. B-ultrasound and CT were the main preoperative imaging methods of examination, and the area under ROC curve (95% CI) of B-ultrasound, CT, MRI and PET/CT for estimation of resectability was 0.524 (0.343–0.705), 0.727 (0.604–0.850), 0.571 (0.000–1.000) and 0.500 (0.010–0.990), respectively. Follow-up data were obtained in 90 patients, and the 1-, 2- and 3-year survival rate was 29%, 16% and 8%, respectively. Univariate analysis suggested that liver metastasis, TNM stage and treatment approach were influential factors for prognosis (all P<0.05). Conclusion: The prognosis of pancreatic cancer is extremely poor, and its estimation of resectability can depend on the CT-based imaging examinations, and liver metastasis, TNM stage and the therapeutic approach are important prognostic factors. Early diagnosis and treatment are important for improving the survival time and prognosis of the patients.

Abstract:Objective: To investigate the clinical diagnosis and treatment efficacy of carcinoma of pancreatic body and tail. Methods: The clinical data of 45 patients with carcinoma of pancreatic body and tail treated in the Affiliated Provincial Hospital of Anhui Medical University from January 2001 to December 2014 were reviewed. The diagnosis, treatment and outcomes of the patients were analyzed. Results: Of the 45 patients, the main symptom was atypical upper abdominal pain (37/45); CA19-9 positive rate was 71.1% (32/45); the detection rate of occupying lesion in the body and tail of the pancreas by B ultrasound and CT was 92.5% (37/42) and 97.8% (44/45), respectively. All patients underwent surgical exploration that included radical resection in 27 cases, palliative bypass drainage in 3 cases, and tumor biopsy plus anhydrous ethanol injection in 15 cases. The perioperative major complication was pancreatic fistula, the incidence of which was 6.7% (3/45). The overall postoperative median survival time was 11 months, in which the median survival time for patients undergoing radical resection was 18 months, and for those undergoing non-radical resection was 5 months, and the difference had statistical significance (χ2=47.1, P<0.05). Conclusion: The clinical symptoms of carcinoma of pancreatic body and tail are atypical, early detection of this disease is difficult, the overall prognosis is poor, and only the promotion of early diagnosis and radical surgery can help improve the patients’ prognosis.

Abstract:Objective: To discuss the experience regarding the diagnosis and treatment of adenosquamous carcinoma of the pancreas so as to improve the knowledge and management of this disease. Methods: The clinical data of 6 patients with adenosquamous carcinoma of pancreas admitted from June 2002 to June 2014 were retrospectively analyzed and discussed with review of the related literature. Results: Of the 6 patients, the lesion was located in the head of the pancreas in 3 cases, and in the body and tail of the pancreas in 3 cases; the average age was 63.3 years. The main symptoms included abdominal pain and yellow urine, and the CA19-9 level was increased in 5 cases. In all of the cases, a space-occupying lesion of the pancreas was suspected by CT and other imaging examinations. Two cases underwent pancreaticoduodenectomy, three cases underwent resection of the body and tail of the pancreas plus splenectomy, and one case had palliative surgery due to involvement of the posterior wall of the stomach and the descending part of the duodenum. Microscopic pathological examination showed that all the tumors consisted of a mixture of adenocarcinoma and squamous cell carcinoma. At postoperative follow-up, 4 cases had died, one case was lost to follow up, and the mean survival time was 21 (7–56) months. Conclusion: Adenosquamous carcinoma of the pancreas is a rare tumor with high malignancy, difficult preoperative diagnosis and poor prognosis. Surgery is still the first therapeutic option for this condition, and its efficacy may be probably improved through combination with radiotherapy and chemotherapy.

Abstract:

Objective: To investigate the expression and action of microRNA-200c (miRNA-200c) in pancreatic cancer stem cells. Methods: Pancreatic cancer stem cells were sorted from human pancreatic cancer PANC-1 cells by FACS using CD24+CD44+ESA+ as marker, and their stem cell properties were assessed by xenograft tumor assay in NOD/SCID mice. The miRNA-200c expression and invasion ability in PANC-1 cells, pancreatic cancer stem cells and pancreatic cancer stem cells transfected with miRNA-200c precursor sequence or negative control sequence were determined by RFQ-PCR method and Transwell invasion assay, respectively. Results: The CD24+CD44+ESA+cells (accounting for 0.8%) sorted from PANC-1 cells presented tumor stem cell properties, and the volume of the xenograft tumor after their subcutaneous transplantation in mice was significantly larger than that after PANC-1 cells transplanted at the same time [(1 725.14±261.29) mm3 vs. (479.65±99.67) mm3, P<0.05]. In pancreatic cancer stem cells compared with PANC-1 cells, the miRNA-200c expression level was significantly decreased (0.15±0.01 vs. 1.00±0.09, P<0.05), and transmembrane cell number was significantly increased (321±7.62 vs. 70±16.47, P<0.05), but the miRNA-200c expression level was significantly increased and transmembrane cell number was significantly decreased in pancreatic cancer stem cells after transfection with miRNA-200c precursor sequence (both P<0.05). Conclusion: MiRNA-200c expression is reduced in pancreatic cancer stem cells, and miRNA-200c has inhibitory effect on growth and invasiveness of pancreatic cancer stem cells.

Abstract:Objective: To observe the killing effect of the cytokine induced killer cells (CIKs) after co-culture with dendritic cells (DCs) harboring K-ras (12-Val) mutant peptide on pancreatic cancer PANC-1 cells. Methods: DCs and CIKs were induced and enriched from peripheral blood of healthy donors, respectively. DCs were loaded with the K-ras mutant epitope peptide (K-ras-DCs), and CIKs were co-cultured with un-loaded DCs or K-ras-DCs to obtain the DC-CIKs and K-ras-DC-CIKs, respectively. The proliferative activities between CIKs and K-ras-DC-CIKs were compared, the difference in immunophenotype between DCs and K-ras-DCs as well as between CIKs and K-ras-DC-CIKs were analyzed, the IFN-γ and IL-12 levels in the culture supernatants from CIKs, DC-CIKs and K-ras-DC-CIKs were measured, and the killing abilities of CIKs, DC-CIKs and K-ras-DC-CIKs on PANC-1 cells in vitro were determined. Results: The proliferative ability of K-ras-DC-CIKs was significantly greater than that of the untreated CIKs (P<0.05); the expressions of the mature surface proteins that included CD1a, CD80, CD83 and HLA-DR in K-ras-DCs were significantly higher than those in un-loaded DCs, while the expression rates of CD3+CD56+ and CD3+CD8+ in K-ras-DC-CIK cell population were significantly higher than those in pure CIK population (all P<0.05); the levels of IFN-γ and IL-12 in the cell culture supernatant, and the killing ability on PANC-1 cells from high to low order were K-ras-DC-CIKs, DC-CIKs, and pure CIKs (all P<0.05). Conclusion: K-ras mutant peptide can promote DCs maturation, and DCs harboring K-ras mutant peptide can increase the proliferation of CIKs and killing effect on pancreatic cancer cells.

Abstract:Objective: To investigate NDRG1 expression and its relation with MMP-7 in pancreatic cancer cells. Methods: The protein and mRNA expressions of NDRG1 and MMP-7 in 4 different pancreatic cancer cell lines (PANC-1, BXPC-3, CAPAN-2 and SW1990) were determined. The interference plasmids siNDRG1 were transfected into PANC-1 cells after their construction, and then the protein and mRNA expressions of NDRG1 and MMP-7, cell proliferation and apoptosis after transfection were determined. Results: All the 4 cell lines presented either the protein or mRNA expressions of both NDRG1 and MMP-7, and their expression levels were increased with decrease of the degree of cell differentiation (all P<0.05). In PANC-1 after siNDRG1 trasfection, the protein and mRNA expressions of both NDRG1 and MMP-7 were reduced, proliferation was suppressed, and apoptosis rate was increased significantly (all P<0.05). Conclusion: NDRG1 expression is closely related to the degree of differentiation of pancreatic cancer cells, and may probably promote cell growth through up-regulating MMP-7 expression.

Abstract:Objective: To investigate the influence of gastric bypass surgery on expressions of insulin receptor (IRc) and insulin receptor substrate 2 (IRS-2) in islet cells of rats with type 2 diabetes mellitus. Methods: The model of type 2 diabetes mellitus in rats was induced by a high fat and high glucose diet plus intraperitoneal streptozotocin injection, and then the rats with establishment of successful model were divided into model group and gastric bypass group, using the normal rats as normal control group. The rats in gastric bypass group underwent gastrojejunostomy and side-to-side jejunojejunostomy, and those in model group and normal control group underwent sham operation. The fasting glucose and serum insulin levels were measured and insulin sensitivity index (ISI) was calculated before and at 8 weeks after operation, and the IRc and IRS-2 expressions in pancreatic tissues were determined by immunohistochemical staining. Results: The fasting glucose levels were increased and ISI values were decreased significantly in both model group and gastric bypass group compared with normal control group before operation, but these two parameters were significantly improved in gastric bypass group compared with model group after operation (all P<0.05); the serum insulin levels showed no significantly difference among groups before and after operation (both P>0.05). In gastric bypass group at 8 weeks after operation, both IRc and IRS-2 expression levels were significantly higher than those in model group (both P<0.05), but IRc expression level was still lower than that in normal control group (P<0.05), while IRS-2 expression level was approximately equal to that in normal control group (P>0.05). Conclusion: IRc and IRS-2 expressions are decreased in islet cells of rats with type 2 diabetes mellitus, and gastric bypass surgery can increase IRc and IRS-2 expression, which may be one of the mechanisms for the therapeutic effect of this surgical procedure on type 2 diabetes mellitus.

Abstract:

Objective: To investigate the clinical features, diagnosis and treatment as well as outcomes of infected pancreatic necrosis (IPN) and IPN complicated with intestinal fistula. Methods: The clinical data of 33 IPN patients, including 10 cases complicated with intestinal fistula, admitted from January 2010 to December 2014 were retrospectively analyzed. Results: All patients underwent standardized treatment in accordance with acute pancreatitis diagnosis and treatment guideline, and patients with intestinal fistula had additional fistula repair or fistula resection and anastomosis, and peritoneal drainage according to the specific conditions. The mortality of the entire group of 33 patients was 39.4% (13/33), and the severity score (2012) was closely associated with the mortality (P<0.05). The mortality of those complicated with intestinal fistula was 40.0% (4/10), and intestinal fistula exerted no impact on the overall mortality (P>0.05), but significantly prolonged the hospital stay of the patients (P<0.05). The mortality in patients with intestinal fistula located in uncommon sites (75%, 3/4) was higher than that in patients with intestinal fistula located in common sites (16.7%, 1/6) (P<0.05). Conclusion: IPN has a relatively high mortality, and although intestinal fistula does not obviously increase mortality of IPN patients, it significantly influences the recovery of the patients, and intestinal fistula in an uncommon site may increase the mortality of the patients.

Abstract:

Objective: To investigate the pathogenic factors, and diagnostic and treatment features of chronic pancreatitis (CP). Methods: The general data, clinical manifestations, therapeutic protocols, and relationship between major risk factors and clinical features in 138 CP patients were retrospectively analyzed. Clinical typing and staging of the patients were performed according to CP Diagnosis and Treatment Guideline of the Chinese Medical Association (2012), and changes of the disease state of the patients between pre- and post-treatment were analyzed based on M-ANNHEIM classification system. Results: Of the 138 patients, abdominal pain was the main symptom in 116 cases (84.1%); cases with regular alcohol consumption accounted for 44.2%, with smoking habit accounted for 42.8%, with hyperlipidemia accounted for 39.9%, and with biliary tract disease accounted for 20.2%, respectively; 11 cases were classified as clinical type I, 58 cases were type II, 47 cases were type III and 22 cases were type IV; 69 cases were at clinical stage I, 47 cases at stage II, and 22 cases at stage III. The proportion of cases with pancreatic calcification in patients with regular alcohol consumption was higher than that in non-alcohol consumers, while either the proportion of cases with pancreatic calcification or diabetes in patients with smoking habit were higher than those in patients who did not smoke (all P<0.05). There was no significant difference in therapeutic results between stage I patients undergoing conservative treatment and surgical treatment (P=0.744), while the therapeutic result of surgical treatment was better than that of conservative treatment in stage II patients, and conservative treatment was better than surgical treatment in stage III patients (both P<0.05). Conclusion: Alcohol consumption, smoking, hyperlipidemia and biliary tract disease are still the main risk factors for occurrence of CP, the features are somewhat different in CP caused by different factors, and choice of plan of treatment should be made on the basis of the Diagnosis and Treatment Guideline and the specific conditions of patients.

Abstract:

Objective: To investigate the clinical value and safety of endoscopic therapy for acute biliary pancreatitis (ABP) during pregnancy. Methods: The clinical data of 35 women with ABP treated from 2000 to 2014 were retrospectively analyzed. Of the patients, 13 cases received conservative treatment (conservative group), and the other 22 cases received minimally invasive endoscopic treatment within 48 h after definite diagnosis was made (endoscopic group). Results: In conservative group, 9 pregnant women (69.2%) were cured, 4 pregnant women (30.8%) died, and fetal death occurred in 6 cases (46.2%). In endoscopic group, 19 pregnant women (86.4%) were cured, of whom 12 cases were cured by endoscopic sphincterotomy (EST), 2 cases were cured by endoscopic nasobiliary drainage (ENBD) and 4 cases were cured by laparoscopic treatment after ENBD, and one case whose condition worsened after endoscopic treatment underwent emergent open surgery and termination of pregnancy, and then recovered but the fetus died; 3 pregnant women (13.6%) died, of whom one case underwent open conversion due to failure of endoscopic treatment, and then developed pancreatic fistula that caused both maternal and fetal death, and 2 cases developed multiple organ failure that caused both maternal and fetal death. The maternal and fetal mortality in endoscopic group were significantly lower than those in conservative group (both P<0.05), moreover, the degree of improvement of laboratory parameters in endoscopic group was better than that in conservative group at 3 d after treatment (all P<0.05). Conclusion: Early endoscopic intervention for ABP patients during pregnancy is safe and effective.

Abstract:

Objective: To investigate the clinical efficacy of endoscopic plus laparoscopic treatment for severe acute pancreatitis (SAP) complicated by pancreatic pseudocyst (PPC). Methods: The clinical data of 52 patients with SAP and PPC undergoing surgical treatment from June 2012 to March 2014 were collected. Of the patients, 31 cases underwent endoscopic plus laparoscopic treatment (endoscopic-laparoscopic group), and 21 cases were subjected to open surgery (open surgery group). The intraoperative conditions, postoperative outcome and recovery as well as incidence of complications were compared between the two groups. Results: In endoscopic-laparoscopic group, the operative time, intraoperative blood loss, time to first flatus and length of postoperative hospital stay were significantly decreased compared with open surgery group (all P<0.05). There was on statistical difference in treatment efficacy rate and incidence of postoperative complications between the two groups (both P>0.05). The incidences of postoperative pain, nausea and vomiting in endoscopic-laparoscopic group were significantly lower than those in open surgery group (all P<0.05). Postoperative follow-up was conducted for 6 months, and no PPC recurrence was noted in any of the two groups. Conclusion: Endoscopic plus laparoscopic procedure has remarkable efficacy and better safety in treatment of SAP with PPC, and individualized treatment strategies can be formulated according to the specific condition of patients. So it is recommended to be used in clinical practice.

Abstract:

Objective: To investigate the impact of ESKAPE bloodstream infection on the prognosis and complications in patients with acute necrotizing pancreatitis (ANP). Methods: Eighty-seven ANP patients admitted from January 2003 to July 2014 with blood culture results were retrospectively studied. Of the patients, 49 cases had negative and 38 cases had positive blood culture. The impact of bloodstream infection, especially ESKAPE bloodstream infection on therapeutic outcomes of these ANP patients was analyzed. Results: In the 69 pathogen test results from the 38 ANP patients with positive blood culture, 40.6% were ESKAPE pathogens that included Acinetobacter baumanni (50.0%), Enterococcus faecium (14.3%), Klebsiella pneumonia (10.7%), Enterobacter species (10.7%), Staphylococcus aureus (7.1%) and Pseudomonas aeruginosa (7.1%). Patients with bloodstream infection had significantly increased incidence of shock, respiratory failure, renal failure and digestive tract bleeding and mortality, as well as increased hospital expenses and prolonged length of ICU stay compared with those without bloodstream infection (all P<0.05). Patients with ESKAPE bloodstream infection had higher incidence of shock and hospital expenses than those with non-ESKAPE bloodstream infection (both P<0.05). Conclusion: Bloodstream infection can significantly increase the complications and mortality in ANP patients. ESKAPE are the major pathogens resulting in bloodstream infection in ANP patients, and are also closely associated with occurrence of shock in the patients.

Abstract:Objective: To investigate the clinical features, diagnostic methods and treatment results of pancreatic cystic neoplasms, so as to provide reference for use in clinical practice. Methods: The clinical data of 112 patients with pancreatic cystic neoplasms admitted from September 2007 to September 2014 were retrospectively analyzed. Results: Of the 112 patients, 111 cases (99.1%) were solitary pancreatic cystic tumor; 81 diagnosed cases (72.32%) had no obvious clinical symptoms, and diagnostic accuracy of ultrasound, CT, MRI and EUS was 86.61%, 89.11%, 93.88%, and 93.33% respectively, which showed no significant difference among the 4 methods of examination (χ2=1.010, P=0.224). Distal pancreatectomy plus splenectomy was performed in 48 patients (42.86%), pancreaticoduodenectomy in 23 cases (20.54%), distal pancreatectomy with spleen preservation in 13 cases (11.61%), and Beger procedure in 3 cases (2.68%). Postoperatively, pancreatic fistula occurred in 18 cases (16.07%), of whom 7 cases (30.43%, 7/23) underwent pancreaticoduodenectomy, 9 cases (18.75%, 9/48) had distal pancreatectomy plus splenectomy, and 2 cases (15.38%, 2/13) received spleen-preserving distal pancreatectomy, and the incidence of pancreatic fistula after pancreaticoduodenectomy was significantly higher than that after the other two procedures (χ2=4.767, P=0.010; χ2=5.854, P=0.007). Pathological examination showed that the lesion in 76 cases (67.86%) was benign, and in 36 cases (32.14%) was malignant. The 5-year survival rate in patients with benign tumor was 100%, and the 1-, and 3- and 5-year survival rate in patients with malignant tumor was 86.96%, 52.17% and 26.08%, respectively. Conclusion: The majority of patients with pancreatic cystic neoplasms have no obvious clinical symptoms. In most cases the tumors are solitary and located in the body and tail of the pancreas, and imaging examinations have high diagnostic accuracy. Benign pancreatic cystic neoplasms have a good prognosis, while aggressive radical resection should be performed for the malignant ones.

Abstract:Due to the complex anatomy and being adjacent to important large vessels, pancreaticoduodenectomy (PD) is a difficult procedure with high risk in the field of general surgery, and is also considered the toughest nut to crack in the field of minimal invasive surgery. For carrying out minimally invasive PD, the surgeons’ considerable experience and skillful surgical technique are crucial to the successful operation. The authors address the progress with regard to minimally invasive PD, so as to clarify the benefits and drawbacks brought by minimally invasive PD, and thereby to further improve the quality of this procedure.

Abstract:Pancreatic cancer is a digestive system tumor with high degree of malignancy, rapid progress and poor prognosis. The early detection of pancreatic cancer is difficult, so that most patients are diagnosed at an advanced stage, have lost the opportunity for surgical therapy, and can only receive adjuvant chemoradiotherapy to help relieve symptoms and control the disease. In recent years, internal radionuclide therapy, with its constant development along with the continuous renewal of treatment strategy, has been increasingly noted in treatment of pancreatic cancer. In this paper, the authors address the advances of internal radionuclide therapy in pancreatic cancer.

Abstract:Microdialysis (MD) is a biochemical micro-detection technique that can continuously sample and analyze the endogenous or exogenous substances in the intercellular fluid, with no impact on the internal environment of the organism. MD can be used to determine not only the local drug pharmacokinetics in internal organs or tumors but also the pathophysiological processes that have metabolic products or organ specificity, and even may be used as an approach for direct delivery and assessment of the local drug in organs and tumors. In this paper, the authors address the application of MD in dealing with pancreas-related research, and discuss its advantages and limitations, as well as the future prospects.

Abstract:With the extension of the enhanced recovery concept, it has also been widely used in pancreaticoduodenectomy (PD). This review mainly addresses the application of enhanced recovery concept in PD, and also discusses some controversial issues.