Pancreatic cancer is a highly malignant tumor in the digestive system and has a low rate of surgical resection and poor prognosis. Since pancreatic cancer has unique biological behaviors, surgical resection alone cannot meet the need of clinical treatment. With the popularization of the concept of multimodality therapy, multidisciplinary collaboration can integrate the superior resources of disciplines and develop standardized and individualized diagnosis and treatment process based on patients′ conditions. It can help clinicians to observe the indications for neoadjuvant therapy in patients with pancreatic cancer and develop individualized surgical and adjuvant treatment regimens and has achieved a good effect in the treatment of pancreatic cancer. This article summarizes the advances and challenges in the multidisciplinary diagnosis and treatment of pancreatic cancer, in order to improve the level of multidisciplinary diagnosis and treatment of pancreatic cancer in China and the prognosis of patients with pancreatic cancer.

Pancreatic cancer is a highly aggressive tumor in the digestive system, and the progress in surgical technique hasn’t improved patients’ prognosis significantly for many years. As the popularization of multidisciplinary team, the role of neoadjuvant therapy has been highlighted in pancreatic cancer. The aim of neoadjuvant therapy is to reduce the tumor size and eliminate micro-metastasis, so as to increase the R 0 resection rate and decrease recurrence and metastasis. Due to the unique tumor microenvironment, pancreatic cancer is not sensitive to chemotherapy and radiotherapy. So neoadjuvant therapy is not effective for all patients, and controversy still exists regarding the patients selection, therapeutic regimen, re-evaluation after neoadjuvant therapy, etc. The application of neoadjuvant therapy is not very mature. At present, we should pay more attention to the role of neoadjuvant therapy in pancreatic cancer. More high-quality clinical researches are urgently needed, and multidisciplinary team should be applied to make personalized treatment strategy in order to improve the prognosis of patients with pancreatic cancer.

The insulinoma, which is the most common pancreatic neuroendocrine tumor, can be misdiagnosed and mistreated easily.Recently, the misdiagnosis rate has decreased significantly owing to the establishment of diagnosis and treatment system.However, the misconception about its diagnosis and treatment still exists because the diagnosis and treatment level varies greatly among different centers.This article aims to summarize the experience in the diagnosis and treatment of insulinoma in Peking Union Medical College Hospital, and introduce the qualitative and localization diagnosis, surgical and interventional treatment and perioperative management about insulinoma, so as to standardize the diagnosis and treatment procedure in China.

Pancreatic neuroendocrine tumors are a group of rare neoplasms originating from the neuroendocrine cells of pancreas.They can be classified into functioning or non-functioning groups according to hormone secretion.Due to the application of high-resolution imaging techniques,the incidence of incidental non-functioning pancreatic neuroendocrine tumors has been rising for decades.Although the optimal prognosis,nonfunctioning pancreatic neuroendocrine tumor are heterogeneous,and the complication morbidity is high.So controversy still exists for the choice of treatment approach.This article aims to summarize and analyze the progress and current controversy about the treatment of incidental non-functioning pancreatic neuroendocrine tumors,and discuss about the appropriate treatment choice for patients.

Pancreatic cancer is extremely malignant and has poor prognosis. Surgery is the only way for the therapy. In recent years, minimally invasive surgery has been developed rapidly in pancreatic surgery. However, pancreatic cancer is often accompanied with vascular aggression and inflammation, which greatly increasing the difficulty of minimally invasive surgery procedure. Its feasibility, safety and radical tumor cure are still controversial. In this article, combined with the existing guidelines and the latest clinical researches, we compared the application of minimally invasive and open surgery in pancreatic cancer and summarized the development status and controversy of minimally invasive treatment of pancreatic cancer. Surgeons should strictly grasp the minimally invasive surgical adaptation certificate, and further carry out clinical research on minimally invasive treatment of pancreatic cancer, so as to standardize and enhance the development of minimally invasive pancreatic surgery in China.

With the development of modern imaging technology and improvement of physical examination consciousness of people, the incidence of pancreatic cystic neoplasm (PCN) has increased significantly. The overall prognosis of PCN is good, and great progress in surgical techniques and multidisciplinary teamwork has been made in pancreatic surgery. Although many guidelines have been released at home and abroad, there are controversies in the differential diagnosis, operative indications, surgical procedure, and the follow-up strategies toward patients with PCN. There are also significant differences in the level of diagnosis and treatment of medical centers, which brings certain challenges to the standardized diagnosis and treatment of PCN. Based on the latest clinical guidelines and new developments in clinical researches, the authors summarize the controversies of different guidelines in the diagnosis, treatment and follow-up of PCN in order to further improve the standardization of the diagnosis and treatment.

Objective:To investigate the effects of mitochondrial arginyl-tRNA synthase (RARS2) on cell proliferation, invasion, migration and chemotherapy resistance of pancreatic cancer.Methods:Human pancreatic cancer cell lines AsPC-1 and PANC-1 were divided into negative control group, RARS2 interference group-1, RARS2 interference group-2, RARS2 overexpression control group and RARS2 overexpression group. Cell proliferation and sensitivity to gemcitabine were detected by CCK-8 assay, and cell invasion and migration were detected by Transwell assay. Western blot was used to detect the expression of RARS2 under different concentrations and different times of gemcitabine treatment. Western blot and PCR were used to detect the expression of RARS2 in gemcitabine-resistant AsPC cell.Results:Inhibition of RARS2 expression in AsPC-1 and PANC-1 cells significantly inhibited cell proliferation and enhanced sensitivity of gemcitabine to chemotherapy. Overexpression of RARS2 enhanced cell proliferation and decreased sensitivity to gemcitabine. In AsPC-1 cells, the number of migrated cells (100×) in negative control group, RARS2 interference group-1, RARS2 interference group-2, RARS2 overexpression control group and RARS2 overexpression group were (586.7±37.4) cells/field, (195.7±18.6) cells/field, (237.0±17.1) cells/field, (157.7±19.1) cells/field, (456.0±23.1) cells/field, the number of invasive cells were (87.7±13.2) cells/field, (24.7±6.5) cells/field, (31.7±6.1) cells/field, (29.3±4.5) cells/field, (94.3±9.3) cells/field, respectively. The migration and invasion ability of cells were decreased after the expression of RARS2 was decreased, and the migration and invasion ability of cells were enhanced after the expression of RARS2 was increased. PCR and Western blot assay showed that RARS2 expression in the gemcitabine-resistant AsPC-1 was higher than that in the common cell line. In AsPC-1 cells, the expression of RARS2 increased with increasing gemcitabine concentration and treatment time.Conclusion:RARS2 promotes cell proliferation, invasion, migration and chemoresistance of pancreatic cancer, and expression of RARS2 is positively correlated with gemcitabine concentration and treatment time.