With the rapid development of modern medical technology,minimally invasive surgical procedures are playing an increasingly important role in the field of pancreatic tumor treatment. This article systematically expounds on the application status of minimally invasive surgical procedures,including robotic surgery and laparoscopic surgery,in the treatment of pancreatic tumors. Through in-depth analysis of various surgical procedures such as pancreatoduodenectomy,distal pancreatectomy,local pancreatic resection,middle pancreatectomy and duodenum-preserving pancreatic head resection,combined with a large amount of high-quality randomized controlled trial research data in the past decade,it systematically discusses the advantages and limitations of minimally invasive surgery compared with traditional open surgery. It also explores the challenges faced by minimally invasive pancreatic surgery in aspects such as high technical difficulty of surgical operations,complex management of postoperative complications and evaluation of oncological radicality. Moreover,it comprehensively looks ahead to the development trends such as the refinement and innovation of future technologies,strengthened multidisciplinary collaboration,and the application of artificial intelligence and big data,aiming to provide references for the clinical practice and research of pancreatic surgery.

With the rapid development of modern medical technology,minimally invasive surgical procedures are playing an increasingly important role in the field of pancreatic tumor treatment. This article systematically expounds on the application status of minimally invasive surgical procedures,including robotic surgery and laparoscopic surgery,in the treatment of pancreatic tumors. Through in-depth analysis of various surgical procedures such as pancreatoduodenectomy,distal pancreatectomy,local pancreatic resection,middle pancreatectomy and duodenum-preserving pancreatic head resection,combined with a large amount of high-quality randomized controlled trial research data in the past decade,it systematically discusses the advantages and limitations of minimally invasive surgery compared with traditional open surgery. It also explores the challenges faced by minimally invasive pancreatic surgery in aspects such as high technical difficulty of surgical operations,complex management of postoperative complications and evaluation of oncological radicality. Moreover,it comprehensively looks ahead to the development trends such as the refinement and innovation of future technologies,strengthened multidisciplinary collaboration,and the application of artificial intelligence and big data,aiming to provide references for the clinical practice and research of pancreatic surgery.

Objective:To compare the perioperative outcomes of laparoscopic duodenal-preserving pancreatic head resection(LDPPHR) with laparoscopic pancreaticoduodenectomy(LPD) in the treatment of borderline and benign diseases of the pancreatic head.Methods:This is a retrospective cohort study. Perioperative data from 87 patients with non-malignant pancreatic head diseases who underwent LDPPHR or LPD were retrospectively collected in the Department of Biliary-Pancreatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2020 to December 2022. There were 49 male and 38 female patients with an age ( M(IQR)) of 57.0(16.5) years (range: 20 to 75 years). Forty patients underwent LDPPHR and 47 patients underwent LPD. Quantitative data following a normal distribution were compared using Student′s t-test, while quantitative data not following a normal distribution were compared using the Mann-Whitney U test. Comparisons of categorical or ordinal variables were made using χ2 test or Fisher′s exact test. Logistic regression analysis was used to estimate the risk factors associated with the rate of complications. Results:There were no statistically significant differences between the LDPPHR group and the LPD group in terms of reoperation rate,total hospital stay duration,postoperative hospital stay duration,90-day mortality rate,30-day and 90-day readmission rates,and 2-year tumor recurrence rate (all P>0.05). The complication rate was higher in the LDPPHR group compared to the LPD group (80.0%(32/40) vs. 51.1%(24/47), χ2=7.89, P=0.005),but there was no difference in the rate of Clavien-Dindo classification of surgical complications ≥Ⅲ between the two groups (10.0%(4/40) vs. 12.8%(6/47), χ2<0.01, P=0.947). Additionally,the rate of delayed gastric emptying (DGE) was higher in the LDPPHR group compared to the LPD group ( χ2=10.79, P=0.001),but there was no statistically significant difference in the rate of B,C grade DGE between the two groups ( χ2=0.48, P=0.487). There were no statistically significant differences in the rates of postoperative pancreatic fistula,bile leakage,post-pancreatectomy hemorrhage,intra-abdominal infection,and pulmonary infection between the two groups (all P>0.05). The results of the univariate logistic regression analysis showed that LDPPHR (compared to LPD, OR=3.83, 95% CI: 1.46 to 10.04, Z=2.73, P=0.006) and preoperative biliary stent placement (compared to non-use of biliary stent, OR=5.30, 95% CI: 1.13 to 25.00, Z=2.11, P=0.035) were risk factors for the complication rate,but neither was an independent risk factor for complication rate (all P>0.05). Conclusion:The preliminary results suggest that LDPPHR can achieve perioperative safety and effectiveness comparable to LPD.

Objective:To compare the perioperative outcomes of laparoscopic duodenal-preserving pancreatic head resection(LDPPHR) with laparoscopic pancreaticoduodenectomy(LPD) in the treatment of borderline and benign diseases of the pancreatic head.Methods:This is a retrospective cohort study. Perioperative data from 87 patients with non-malignant pancreatic head diseases who underwent LDPPHR or LPD were retrospectively collected in the Department of Biliary-Pancreatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2020 to December 2022. There were 49 male and 38 female patients with an age ( M(IQR)) of 57.0(16.5) years (range: 20 to 75 years). Forty patients underwent LDPPHR and 47 patients underwent LPD. Quantitative data following a normal distribution were compared using Student′s t-test, while quantitative data not following a normal distribution were compared using the Mann-Whitney U test. Comparisons of categorical or ordinal variables were made using χ2 test or Fisher′s exact test. Logistic regression analysis was used to estimate the risk factors associated with the rate of complications. Results:There were no statistically significant differences between the LDPPHR group and the LPD group in terms of reoperation rate,total hospital stay duration,postoperative hospital stay duration,90-day mortality rate,30-day and 90-day readmission rates,and 2-year tumor recurrence rate (all P>0.05). The complication rate was higher in the LDPPHR group compared to the LPD group (80.0%(32/40) vs. 51.1%(24/47), χ2=7.89, P=0.005),but there was no difference in the rate of Clavien-Dindo classification of surgical complications ≥Ⅲ between the two groups (10.0%(4/40) vs. 12.8%(6/47), χ2<0.01, P=0.947). Additionally,the rate of delayed gastric emptying (DGE) was higher in the LDPPHR group compared to the LPD group ( χ2=10.79, P=0.001),but there was no statistically significant difference in the rate of B,C grade DGE between the two groups ( χ2=0.48, P=0.487). There were no statistically significant differences in the rates of postoperative pancreatic fistula,bile leakage,post-pancreatectomy hemorrhage,intra-abdominal infection,and pulmonary infection between the two groups (all P>0.05). The results of the univariate logistic regression analysis showed that LDPPHR (compared to LPD, OR=3.83, 95% CI: 1.46 to 10.04, Z=2.73, P=0.006) and preoperative biliary stent placement (compared to non-use of biliary stent, OR=5.30, 95% CI: 1.13 to 25.00, Z=2.11, P=0.035) were risk factors for the complication rate,but neither was an independent risk factor for complication rate (all P>0.05). Conclusion:The preliminary results suggest that LDPPHR can achieve perioperative safety and effectiveness comparable to LPD.

Objective To explore the expression of miR-548j-5p in pancreatic cancer and its effect on the invasion of pancreatic cancer. Methods Tissue samples of 16 patients with pancreatic cancer who received treatment in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science &Technology between January 2016 and January 2017 were collected. There were 8 males and 8 females, aged from 41 to 62, including 7 cases with an age of ≤50 and 9 cases with an age of >50. The informed consents of all patients were obtained and the local ethical committee approval was received. The expression of miR-548j-5p in pancreatic cancer and adjacent tissues was detected by RT-PCR. PANC-1 cells were transfected by mimic and inhibitor of miR-548j-5p to construct PANC-1 cells with over-expression and low-expression of miR-548j-5p. And in control group, PANC-1 cells were transfected with empty plasmid Ctrl. The effect of miR-548j-5p on PANC-1 invasion was detected by Transwell assay, and its effect on PANC-1 metastasis was evaluated by wound scratch assay. Comparison of three groups was conducted by one-way analysis of variance and LSD-t test. Results The median relative expression of miR-548j-5p in pancreatic cancer was 0.35(0.03-4.47), significantly lower than 4.30 (0.04-65.55) in adjacent tissues (Z=-2.689, P<0.05).Transwell assay results showed that the average number of cells penetrating membrane was(58±34) in miR-548j-5p over-expression group, significantly lower than (231±61) in control group (LSD-t=-2.852, P<0.05);and it was(491±149)in miR-548j-5p low-expression group,significantly higher than that in control group (LSD-t=4.313, P<0.05). The wound scratch assay results showed that the wound scratch healing rate was (20±8)% in miR-548j-5p over-expression group, significantly lower than (38±6)% in control group (LSD-t=-3.759, P<0.05); and it was (53±6)% in miR-548j-5p low-expression group, significantly higher than that in control group (LSD-t=2.946, P<0.05). Conclusions Low expression of miR-548j-5p is observed in pancreatic cancer. Over expression of miR-548j-5p can decrease the invasive and metastatic ability of pancreatic cancer.

Objective To investigate the clinical value of arterial first approach in laparoscopic pancreaticoduodenectomy (LPD).Methods The retrospective cohort study was conducted.The clinicopathological data of 181 patients with pancreatic head and periampullay tumors who underwent LPD in the Affiliated Tongji Hospital of Huazhong University of Science and Technology between October 2014 and December 2016 were collected.Among 181 patients,96 using arterial first approach and 85 using traditional approach were respectively allocated into the experimental group and the control group.Surgery was applied to patients in the same doctors' team,and there were the same extent of surgical resection,range of lymph node dissection and digestive tract reconstruction.Observation indicators:(1) intraoperative situation;(2) postoperative situation;(3) followup and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect the tumor-free survival up to February 2017.Measurement data with normal distribution were represented as x±s,and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range).Comparison of count data were analyzed using the chi-square test or Fisher exact probability.Results (1) Intraoperative situation:all the patients underwent successful LPD.Overall operation time and time of digestive tract reconstruction were respectively (268 ± 20) minutes,(33 ± 10) minutes in the experimental group and (285±25)minutes,(30± 17)minutes in the control group,with no statistically significant difference between 2 groups (t =8.529,2.741,P＞ 0.05).Time of tumor resection with superior mesenteric venous invasion were respectively (216± 13)minutes and (264±22)minutes in the experimental and control groups,with a statistically significant difference between the 2 groups (t=41.826,P＜0.05).Time of tumor resection without superior mesenteric venous invasion were respectively (224± 14) minutes and (215±21) minutes in the experimental and control groups,with no statistically significant difference between the 2 groups (t =7.423,P＞ 0.05).Volumes of intraoperative blood loss and blood transfusion were respectively (99± 16)mL,(1.3±0.8)U in the experimental group and (131±27)mL,(2.8±1.2)U in the control group,with statistically significant differences between the 2 groups (t =3.670,0.562,P＜ 0.05).Five and 8 patients had intraoperative blood transfusion in the experimental and control groups,showing no statistically significant difference between the 2 groups (x2=1.195,P＞0.05).(2) Postoperative situation:time of drainage tube removal and duration of hospital stay were respectively (5.8±2.4)days,(18.3±6.3) days in the experimental group and (6.3±3.6)days,(19.6±7.1) days in the control group,with no statistically significant difference between the 2 groups (t =0.498,1.305,P＞0.05).Eleven patients in the experimental group had postoperative early complications,including 8with grade A pancreatic fistula (4 combined with diarrhea,2 combined with biliary fistula,1 combined with delayed gastric emptying and 1 with single pancreatic fistula),3 with grade B pancreatic fistula (2 combined with intra-abdominal hemorrhage and 1 combined with intra-abdominal infection).One patient with intra-abdominal hemorrhage in the experimental group died after treatment failure.Twelve patients in the control group had postoperative early complications,including 6 with grade A pancreatic fistula (2 combined with biliary fistula,2 combined with delayed gastric emptying,1 combined with diarrhea,1 combined with digestive tract hemorrhage),3 with grade B pancreatic fistula and intra-abdominal hemorrhage (2 combined with infection,including 1 death) and 3 with diarrhea.Other patients with complications were cured by symptomatic and supportive treatment.There was no statistically significant difference in overall complications between the 2 groups (x2 =0.287,P＞0.05).Results of postoperative pathological examination showed that case with R0 resection was 93 and 76 in the experimental and control groups,with a statistically significant difference between the 2 groups (x2 =4.057,P＜0.05).(3) Follow-up and survival situations:179 patients were followed up for 2-28 months,with a median time of 14 months.Postoperative 6-month tumor-free survival rate was 92.7％ (89/96) and 88.2％(75/85) in the experimental and control groups,with no statistically significant difference between the 2 groups (x2=1.060,P＞0.05).Conclusion Arterial first approach in LPD could significantly shorten the time of tumor resection of patients with superior mesenteric artery invading pancreatic head and periampullay region,significantly reduce the volumes of intraoperative blood loss and blood transfusion,and increase the rate of R0 resection.

Objective To summerize the experiences of using random flaps to reconstruct soft tissue defects of the periorbital region.Methods Periorbital soft tissue defects in 65 patients underwent reconstruction surgery by random flaps with pedicle 1.0～2.5 cm in width.The length of the flap ranged from 1.0 cm to 3.5 cm,with the rate of length to width less than 2.5:1.Detail plans on flap and incision design were made based on the aesthetic and functional problems.Results Phenomena of blister and purplish red in the edge or the distal area of the flaps were observed in 3 cases,and were disappeared after corresponding treatment.The other flaps survived and the wound healed primarily after operation.The color and the texture of the flaps matched well to the adjacent tissues with satisfied function and aesthetic Results .Conclusion Random flap is an ideal substitute to repair periorbital soft tissue defects.