Objective: To investigate the clinical value of penetrating-suture pancreaticojejunostomy. Methods: The clinical data of 83 patients undergoing pancreaticoduodenectomy (PD) from May 2006 to July 2014 were retrospectively analyzed. All patients received penetrating-suture pancreaticojejunostomy for pancreatic-enteric anastomosis during surgery, which was characterized by anastomosis of the cutting surface (not the cutting margin) of the pancreas to the jejunal wall, and anastomosis of the pancreatic duct to the intestinal mucosa. Results: Of 83 patients, 32 cases were carcinoma of the pancreatic head, 42 cases were periampullary carcinoma and 9 cases had other conditions; 81 cases underwent radical pancreaticoduodenal resection and two cases had non-radical resection. The operative time was 220 to 350 min, with an average of 290 min, and the time for pancreatic-enteric anastomosis was 6 to 22 min, with an average of 8 min. According to ISGPF criteria, clinically significant postoperative pancreatic fistula occurred in 8 cases, and all were grade B simple pancreatic fistulas. Bile leakage occurred in 2 cases and delayed gastric emptying occurred in 6 cases. No reoperation was needed and no anastomotic bleeding or surgical death occurred. Conclusion: The technique of penetrating-suture pancreaticojejunostomy can effectively prevent postoperative anastomotic failure at the pancreatic-enteric anastomosis and anastomotic bleeding.

Objective: To determine the clinical application value of laparoscopic pancreaticoduodenectomy (PD) with an uncinate process approach. Methods: The clinical data of 12 patients undergoing laparoscopic PD with uncinate process approach since February 2010 were reviewed. The essential feature of the operation was dissection of the uncinate process and the mesentery upwards along the right side of the superior mesenteric artery from the horizontal part of the duodenum, and then proceeding to conduct the other surgical procedures in the conventional order. Results: Of the 12 patients, 2 cases were converted to open surgery, and remaining 10 cases had successful laparoscopic PD. The operative time for laparoscopic PD was 240 to 340 min with an average of 280 min, the intraoperative blood loss was 150 to 1 200 mL with an average of 300 mL, and the number of dissected lymph nodes was 9 to 15 with an average number of 10. Postoperative pathological examination showed negative surgical margins. Postoperative pancreatic leakage and bile leakage occurred in 2 patients and 1 patient respectively, which were all cured after treatment. Conclusion: Laparoscopic PD with uncinate process-first approach is a safe, feasible and effective surgical procedure.

Objective: To assess the efficacy of pancreaticoduodenectomy (PD) followed by tegafur/gimeracil/oteracil (S-1) adjuvant chemotherapy in treatment of pancreatic cancer. Methods: Between February 2008 and June 2011, 58 patients with stage I-II pancreatic cancer underwent PD followed by postoperative adjuvant chemotherapy with S-1 (32 cases, observational group) or gemcitabine (26 cases, control group). The short- and long- term efficacies as well as the incidence of adverse events during chemotherapy between the two groups of patients were compared. Results: The levels of serum tumor markers in both groups of patients were significantly decreased after chemotherapy compared with their levels before chemotherapy (all P<0.05), but showed no significant difference between the two groups (all P>0.05); the overall response rate in observational group was significantly higher than that in control group (37.50% vs. 30.77%, P<0.05); survival analysis showed that the 1-, 1.5- and 2-year overall survival rate in observational group were significantly higher than those in control group (all P<0.05); the adverse reactions in either group were grade I or II, and there was no significant difference in incidence of adverse reactions between the two groups (P>0.05). Conclusion: PD plus postoperative S-1 adjuvant chemotherapy for pancreatic cancer patients has proven efficacy, which may effectively prolong the postoperative survival time of the patients, with only mild adverse effects, and good tolerance.