The special suppressive tumor immune microenvironment is a significant factor in the high postoperative recurrence rate and insensitivity to immunotherapy in pancreatic cancer. Tertiary lymphoid structures (TLSs) are pathologic ectopic lymphoid tissues composed of various immune cells, playing a crucial role in regulating adaptive anti-tumor immune responses. The presence of TLSs in pancreatic cancer tissues signifies better prognosis and immune therapy response. Examining the quantity, location, maturity, and cellular components of TLSs in pancreatic cancer specimens helps predict prognosis and screen potential beneficiaries of immunotherapy. Exploring key factors inducing TLSs formation and elucidating the anti-tumor immune mechanisms of TLSs may provide a new theoretical basis for enhancing the efficacy of pancreatic cancer immunotherapy. The authors summarize the clinical status and hot topics of TLSs in pancreatic cancer applications, and look forward to the research directions of TLSs in the field of pancreatic cancer.

Objective:To investigate the application value of nectin-4 targeting radiotracer 68Ga-N188 in the diagnosis of pancreatic cancer. Methods:The prospective study was conducted. The clinicopathologic data of 16 patients diagnosed as pancreatic cancer on enhanced computed tomography (CT) who were admitted to the Peking University First Hospital from August to December 2022 were collected. There were 9 males and 7 females, aged (62±8)years. All patients underwent 18F-flurodeoxyglucose ( 18F-FDG) and 68Ga-N188 positron emission tomography (PET)/CT examination. Observation indicators: (1) distribution of 68Ga-N188 in different tissues and tumor primary lesion of patients; (2) expression of Nectin-4 and uptake of 68Ga-N188 in pancreatic cancer; (3) comparison of examination results between 68Ga-N188 and 18F-FDG PET/CT. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Count data were described as absolute numbers or percentages. Results:(1) Distribution of 68Ga-N188 in different tissues and tumor primary lesion of patients. Results of PET/CT examination showed that in 1 hour after injection, the maximum standard uptake value (SUVmax) and mean standard uptake value (SUVmean) of 68Ga-N188 in fat, muscle, skin, and brain tissues of 16 patients were 0.40±0.16 and 0.25±0.09, 0.68±0.20 and 0.44±0.12, 0.39±0.14 and 0.28±0.11, 0.09±0.04 and 0.05±0.02, respectively. In the tissues of the esophagus, liver, spleen, and pancreas, the above indicators were 1.53±0.48 and 1.16±0.31, 1.49±0.45 and 0.91±0.30, 1.40±0.30 and 1.02±0.24, 1.24±0.31 and 0.96±0.25, respectively. In tumor primary lesion, the above indicators were 3.28±1.02 and 2.14±0.62, respectively, showing significant differences in SUVmax and SUVmean compared with pancreatic tissue ( t=8.03, 6.75, P<0.05). The tumor background ratio in tumor primary lesion based on SUVmax was 1.82±0.58. (2) Expression of Nectin-4 and uptake of 68Ga-N188 in pancreatic cancer. Results of immunohistochemical staining in 16 patients showed that there were 7 patients with high Nectin-4 expression and 9 patients with low Nectin-4 expression. Results of PET/CT examination showed that the SUVmax of 68Ga-N188 in tumor primary lesion of the 7 patients with high Nectin-4 expression and 9 patients with low Nectin-4 expression were 3.77±1.10 and 2.64±0.68, showing a significant difference between them ( t=2.64, P<0.05). The SUVmax of 18F-FDG in tumor primary lesion of the 7 patients with high Nectin-4 expression and 9 patients with low Nectin-4 expression were 6.73±3.24 and 6.43±3.45, showing no significant difference between them ( t=0.17, P>0.05). (3) Comparison of examination results between 68Ga-N188 and 18F-FDG PET/CT. Of the 16 patients, cases with positive results of tumor primary lesion on 68Ga-N188 and 18F-FDG PET/CT were 14 and 11, respectively, for the 14 pancreatic cancer patients diagnosed by postoperative histopathology. Among them, cases with positive results of tumor primary lesion on 68Ga-N188 and 18F-FDG PET/CT were 3 and 1 for the 3 pancreatic cancer patients receiving evaluation for chemotherapy. The SUVmax of 18F-FDG in tumor primary lesion of the 3 patients with chemotherapy and the 11 patients without chemotherapy were 2.80±0.69 and 6.97±2.11, showing a significant difference between them ( t=3.29, P<0.05). The SUVmax of 68Ga-N188 in tumor primary lesion of the 3 patients with chemotherapy and the 11 patients without chemotherapy were 3.38±1.12 and 2.93±0.50, showing no significant difference between them ( t=0.66, P>0.05). Cases with positive results of lymph node metastases in 68Ga-N188 and 18F-FDG PET/CT were 6 and 4, respectively, for the 6 pancreatic cancer patients diagnosed with lymph node metastases by postoperative histopathology, and the SUVmax of 68Ga-N188 and 18F-FDG in lymph node metastases were 2.25±1.12 and 4.02±1.27. Conclusion:68Ga-N188 PET/CT can be used for imaging diagnosis of tumor primary lesion and lymph node metastases of pancreatic cancer.

In recent years, the concept and pathways of enhanced recovery after surgery (ERAS) have been extensively applied in abdominal surgery. Pancreaticoduodenectomy (PD), as a major surgical procedure, is characterized by its complexity, prolonged operative time, high complication rate, and slow postoperative recovery. The adoption of ERAS principles and pathways in the perioperative management of PD has been relatively delayed. In addition to general concerns such as prehabilitation, fluid management, nutritional support, and multimodal analgesia, some specific issues unique to pancreatic surgery, including the necessity and duration of postoperative gastrointestinal decompression and abdominal drainage, as well as postoperative dietary management, is what really demanding special consideration. Although high-quality studies, both domestic and international, have demonstrated the safety of ERAS, its adherence in clinical practice remains limited, and controversies regarding their implementation persist. Particularly in the context of the widespread adoption of minimally invasive surgery, it is imperative to explore strategies that maximize the advantages of minimally invasive surgery and ERAS, while balancing the general principles of perioperative management with the considerations specific to pancreatic surgery, thereby optimizing patient outcomes. This review provides an overview of the current status and recent advances in the application of ERAS during the perioperative period of PD, with the aim of promoting their standardized and rational implementation.

With the improvement of surgical techniques and deeper anatomical understanding, the concept of precision surgery has gradually developed. The necessity of traditional extensive organ resection for the treatment of benign and borderline tumors is being challenged due to the high risk of long-term complications. Over the past 40 years, various modified surgical techniques have emerged, with duodenum-preserving pancreatic head resection as a representative procedure. The surgical indications have gradually transitioned from chronic pancreatitis to benign and borderline tumors of the pancreatic head. The extent of resection has evolved from major partial resection and subtotal resection to total resection of the pancreatic head. The surgical approach has also progressed from traditional open surgery to minimally invasive techniques such as laparoscopic or robot-assisted surgery, reflecting updates and optimizations in treatment concepts and surgical methods. This paper discusses the development, surgical indications, and related complications of duodenum-preserving pancreatic head resection. The aim is to provide a reference for the more standardized and rational selection of this surgical procedure in clinical practice while reducing the incidence of complications.

With the improvement of surgical techniques and deeper anatomical understanding, the concept of precision surgery has gradually developed. The necessity of traditional extensive organ resection for the treatment of benign and borderline tumors is being challenged due to the high risk of long-term complications. Over the past 40 years, various modified surgical techniques have emerged, with duodenum-preserving pancreatic head resection as a representative procedure. The surgical indications have gradually transitioned from chronic pancreatitis to benign and borderline tumors of the pancreatic head. The extent of resection has evolved from major partial resection and subtotal resection to total resection of the pancreatic head. The surgical approach has also progressed from traditional open surgery to minimally invasive techniques such as laparoscopic or robot-assisted surgery, reflecting updates and optimizations in treatment concepts and surgical methods. This paper discusses the development, surgical indications, and related complications of duodenum-preserving pancreatic head resection. The aim is to provide a reference for the more standardized and rational selection of this surgical procedure in clinical practice while reducing the incidence of complications.

The construction of National Regional Centers is a significant strategic deployment to promote the expansion of high-quality medical resources and a balanced regional layout.It introduces the performance of Peking University First Hospital in promoting the construction of National Regional Centre for women and children's hospital with the work mode of"geographical homogenization construction",summarizes effectiveness.It is believed that government support is the foundation,output hospital sinking is the key,and input hospital participation is the guarantee.

The construction of National Regional Centers is a significant strategic deployment to promote the expansion of high-quality medical resources and a balanced regional layout.It introduces the performance of Peking University First Hospital in promoting the construction of National Regional Centre for women and children's hospital with the work mode of"geographical homogenization construction",summarizes effectiveness.It is believed that government support is the foundation,output hospital sinking is the key,and input hospital participation is the guarantee.

The construction of National Regional Centers is a significant strategic deployment to promote the expansion of high-quality medical resources and a balanced regional layout.It introduces the performance of Peking University First Hospital in promoting the construction of National Regional Centre for women and children's hospital with the work mode of"geographical homogenization construction",summarizes effectiveness.It is believed that government support is the foundation,output hospital sinking is the key,and input hospital participation is the guarantee.

The construction of National Regional Centers is a significant strategic deployment to promote the expansion of high-quality medical resources and a balanced regional layout.It introduces the performance of Peking University First Hospital in promoting the construction of National Regional Centre for women and children's hospital with the work mode of"geographical homogenization construction",summarizes effectiveness.It is believed that government support is the foundation,output hospital sinking is the key,and input hospital participation is the guarantee.

The construction of National Regional Centers is a significant strategic deployment to promote the expansion of high-quality medical resources and a balanced regional layout.It introduces the performance of Peking University First Hospital in promoting the construction of National Regional Centre for women and children's hospital with the work mode of"geographical homogenization construction",summarizes effectiveness.It is believed that government support is the foundation,output hospital sinking is the key,and input hospital participation is the guarantee.