Pancreatic head cancer is one of the most malignant tumor in gastrointestinal tract, which has the characteristics of rapid progression and low resection rate due to the involving of superior mesenteric vessels and portal vein. Pancreaticoduodenectomy still plays the center role in surgical management of pancreatic head cancer, however it remains some controversial in operative methods choice and extended pancreatectomy procedure. Surgeons should take sufficient considerations and make appropriate strategy preoperatively to ensure the safety, resectability and radical resection of surgery treatment.

Insulinoma is derived from beta cells, and the yearly incidence of insulinoma is 1-4 per one million. Insulinoma patients were often misdiagnosed with epilepsy or cerebrovascular diseases because of the clinical and epidemiological features of insulinoma. The diagnosis of the insulinoma is usually made biochemically with the presence of low blood glucose ( <2.5 mmol/L), elevated insulin ( ≥6 mU/L) and C-peptide levels ( ≥ 200 pmol/L), and no sulfonylureas in the blood.Supervised 72-hour fasting test has been verified as the gold standard in establishing a biochemical diagnosis of insulinoma.Localization of insulinoma is useful for selecting surgical procedures, and the methods for localization can be divided into noninvasive (transabdominal ultrasound, computed tomography,magnetic resonance imaging and endoscopic ultrasound), invasive (angiography and arterial stimulation venous sampling) and intraoperative diagnosis. Surgical treatment is the only curative method at present, and the common approaches include enuclea tion, partial pancreatic resection, resection of the body and tail of pancreas and duodenum-preserving pancreatic head resection.Most patients with sporadic insulinoma had long-term survival after the surgery. For insulinoma patients with multiple endocrine neoplasia type 1, an aggressive surgical approach is recommended.

Pancreatic cancer is the most lethal common cancer and the most complicated disease to diagnose and treat.A large amount of clinical researches have been conducted in the area of pancreatic cancer over the past century,which have directly improved the level of diagnosis and treatment for pancreatic cancer.Through reviewing the achievements of clinical researches for pancreatic cancer,the approaches to carry out high-level clinical researches and the importance of surgeons' participation in clinical research,this article aims to promote the development of clinical researches for pancreatic cancer,and improve the level of diagnosis and treatment for pancreatic cancer.

For decades,the improvement of diagnosis and treatment of pancreatic cancer is being extremely difficult,and the survival rates remain extremely low.The primary objective of translational medicine is to remove the barriers among basic medical research,clinical medicine,new therapies and pharmaceutical research and development,to realize the actual combination of laboratory,clinical and other related departments,and accelerate the translation of acquired knowledge and achievements in basic research into clinical diagnosis,evaluation and treatment of diseases,promoting the spread of scientific clinical notion and methods.To strengthen the translational medical research in pancreatic cancer,the establishment of professional team and research platform of translational medicine is necessary.Based on this platform,comprehensive research on early diagnosis and pathogenesis of pancreatic cancer can be carried out to screen highly efficient tumor markers and treatment targets.For these tumor markers and targeted drugs need to be further verified in clinics.At the same time,through appropriate animal model,the chemotherapy regimen can be optimized to improve the chemotherapy sensitivity,and individual treatment can truly be achieved.

Periampullary cancer is a kind of malignant cancer of digestive tract.It arises within 2 cm of the major duodenal papilla and eomprises cancers of the ampulla,distal comliiOll bile duct,pancreas and duodenum.Their clinical features and anatomic locations are similar,as are the therapeutic approaches.However,their long-term outcomes vary.Due to the bad prognosis,it is very important to make an early,accurate diagnosis and differential diagnosis of periampullary cancer.This article summarizes some basic methods and new developments of early and differential diagnosis of poriampullary cancer.

Hedgehog (Hh) signaling is critical for embryonic development and in differentiation,proliferation,and maintenance of multiple adult tissues.Deregulation of the Hh pathway is associated with Multiple pathological steps of PDAC(Pancreatic ductal adenocarcinoma).A prominent desmoplastic stromal reaction is the pathological hallmark of PDAC,it contributes to the formation of the hypovascular and hypoxic microenvironment of PDAC.And Hedgehog signaling is one of the most crucial pathways that maintains and activates the stroma.Clinical trials of Hedgehog signaling inhibitors in treatment of PDAC has been conducted,but results have been disappointing.Recently,to undercover the reason of the failure of clinical trial,more work has been done to uncovering the underlying role of stroma in PDAC.

Objective To summarize the diagnosis and treatment of abdominal Castleman disease.Methods The clinical data of 17 patients with abdominal Castleman disease who were admitted to Peking Union Medical College Hospital were retrospectively analysed. Eleven patients had no symptoms, two had an abdominal mass, two had oral ulcers and rash, one had edema and was short of breath and one had dull pain in the upper abdomen and vomiting. Two patients were examined by X-ray, 17 by ultrasound, and 13 by computed tomography(CT). Results Four patients were diagnosed with abdominal Castleman disease by CT preoperatively, and the remaining 13 patients were not conclusively diagnosed. Localized lesions of 14 patients were completely resected,and three patients with multicentric lessions received partial resection or biopsy. The diagnosis of all patients was confirmed by histopathological examination. The expression of CD3, CD20, CD21 and CD34 of 14 patients with hyaline-vascular type was positive, and the expression of CD3, CD68 and PCNA of three patients with plasma-cell type was positive. One patients was lost of follow up, and the remaining 16 patients were followed up for 3-12 months, and neither metastasis nor recurrence was observed. Conclusions The clinical manifestations of abdominal Castleman disease are nonspecific, and therefore, it is difficult to acquire a definite diagnosis before operation. Early complete resection should be applied to patients with localized Castleman disease, while for patients with multicentric Castleman disease, postoperative chemotherapy is necessary for a good prognosis.

Objective To investigate the diagnosis and treatment of mesenteric fibromatosis.Methods We analyzed retrospectively the clinical data including clinical manifestation,treatment and follow-up results of the mesenteric fibromatosis in 11 cases.ResultsNine patients presented with abdominal mass.Two cases were found during other operation occasionally.Before operation,3 cases were misdiagnosed as leiomyosarcoma,1 case as malignant neurilemmoma,1 case as lymphoma.All patients were underwent surgical resection,and were diagnosed as mesenteric fibromatosis by pathology.Following-up,from 7 months to 72 months,2 cases relapsed.Conclusions The clinical feature of mesenteric fibromatosis is nonspecific.It is difficult to make correct diagnosis preoperatively.Surgical resection is the first choice for cure of patients with mesenteric fibromatosis.

Drug resistance is major obstacles in the successful treatment of malignant solid tumors. Multiple mechanisms involeve in development of cancer drug resistance. Recent research suggests dysregulation of microRNAs is associated with cancer drug resistance. The profiles of microRNAs in drug resistance cancer cells or tissues are different with sensitivity cells or tissues in various solid tumors. Restoring microRNAs could improve chemosensitivity of cancer cells. MicroRNAs expression profiles may provide a critical link for understanding mechanisms involved in chemoresistance. We can also find a specific marker for screening chemosensitivity patients through identification of the microRNAs patterns of drug resistance cells or tissues.

Objective To summarize the experience in diagnosis and treatment of intraductal papillary mucinous neoplasm(IPMN) of the pancreas and identify potential preoperative factors predicting invasiveness of intraductal papillary mucinous neoplasm of the pancreas. Methods From September 2003 to July 2010,27 patients underwent pancreatic resection for IPMN. All cases were divided into invasive and noninvasive groups. Preoperative medical records were reviewed retrospectively between the two groups. Results Pathological results revealed 15 cases of invasive IPMN and 12 noninvasive cases. The incidence of obstructive jaundice, tumor size and serum total bilirubin values were significantly different between the two groups. The other factors including sex ratio, age, incidence of abdominal pain or back pain, diarrhea, weight loss, new onset diabetes, serum CEA, CA19-9 values showed no statistical difference. Conclusion Serum total bilirubin≥22.2μmol/L and tumor size≥3 cm could be predicting factors of invasive IPMN.