Pancreatic cancer is the most challenging issue in the field of pancreatic surgery. Accurate preoperative diagnosis is the key to improving prognosis. Currently, there have been research reports on the application of artificial intelligence(AI) in the early diagnosis, differential diagnosis, and stratified diagnosis of pancreatic cancer. This article summarized the representative studies and focused on introducing their innovative thinking, modeling methods, research results, and clinical significance, demonstrating the application potential of AI in preoperative diagnosis of pancreatic cancer, with the aim of providing inspiration for subsequent research in this field.

Pancreatic cancer is a highly malignant digestive system tumor. Due to its rapid progression and difficulty in early diagnosis, patients are often diagnosed at an advanced stage or with metastases. Liver is the most common metastatic site of pancreatic cancer, and its prognosis and treatment are not optimistic. In recent years, with the progress of basic research, the research on the molecular mechanism of liver metastasis in pancreatic cancer has also made great progress. This paper briefly summarize the current progress of molecular mechanism research of liver metastasis in pancreatic cancer.

Objective:To explore whether perioperative oral probiotic therapy reduces infectious complications following pancreaticoduodenectomy (PD), aiming to obtain higher-level evidence for clinical practice.Methods:A total of 81 participants undergoing PD at the Department of Pancreatic and Metabolic Surgery, Nanjing Drum Tower Hospital & Affiliated Hospital of Medical School, Nanjing University, from May 2024 to December 2024 were enrolled in this single-center, prospective, randomized controlled trial. The participants were randomly divided into a probiotic treatment group and a control group (receiving conventional treatment without probiotics) using a random number method. The primary outcomes included the incidence of postoperative infectious complications and intra-abdominal infection, and the secondary outcomes were the recovery of gastrointestinal function, postoperative hospital stay, and duration and costs of antibiotic use. The hematological indicators including inflammation and immune markers on postoperative days (POD) 1, 3, 5, and 7 were also compared between these two groups.Results:Finally 72 cases (39 males and 33 females) were analyzed, with 36 patients in the probiotic treatment group and 36 patients in the control group. Compared to the control group, the probiotic treatment group showed statistically significant reductions in the incidence of infectious complications (33.3% vs. 66.7%, P=0.029), intra-abdominal infection (27.8% vs. 58.3%, P=0.030), and incidence of delayed gastric emptying (0 vs. 16.7%, P=0.033). Also, the probiotic treatment group exhibited significantly faster recovery in postoperative bowel movements and shorter time to defecation, liquid diet, and semi-liquid diet (all P<0.05). Additionally, the probiotic treatment group had significantly shorter hospital stay, reduced duration of antibiotic use, and lower antibiotic costs (all P<0.05). Finally, the probiotic treatment group had significantly higher lymphocyte counts on POD 1 ( P<0.05) and showed a significant downward trend in inflammatory markers such as interleukin-6 on PODs 3 and 5 and C-reactive protein on POD 7 (all P<0.05). Conclusions:Perioperative application of probiotic preparations in PD may reduce the incidence of postoperative infectious complications, especially intra-abdominal infection. Additionally, it can prevent delayed gastric emptying, promote the recovery of postoperative gastrointestinal function, shorten hospital stay, and reduce the use of antibiotics. These benefits may be related to the improvement of postoperative inflammatory status.

Pancreatic cancer is a highly aggressive malignancy with a poor prognosis,and surgical resection remains the only potentially curative treatment.However,since most patients are diagnosed at a locally advanced or metastatic stage,the feasibility of upfront surgery is limited.In recent years,neoadjuvant and conversion therapy have emerged as crucial strategies for borderline resectable and locally advanced pancreatic cancer,aiming to increase the R0 resection rate and improve survival outcomes.Studies have shown that FOLFIRINOX and gemcitabine plus nab-paclitaxel are commonly used neoadjuvant chemotherapy regimens,with the former being more suitable for patients with good performance status,while the latter is better tolerated across a broader patient population due to its lower toxicity.Additionally,radiotherapy,such as stereotactic body radiotherapy(SBRT),can enhance local tumor control,increase tumor cell eradication,and minimize damage to normal tissues,thereby optimizing overall treatment efficacy.Despite the significant advantages of this approach,challenges remain,including the management of toxic side effects and the optimization of treatment protocols.Future research will focus on personalized precision medicine,integrating genomic sequencing and radiomics to refine neoadjuvant/conversion therapy strategies and exploring the combination of chemotherapy,radiotherapy,immunotherapy,and targeted therapy to improve long-term survival in pancreatic cancer patients.This paper summarizes recent advancements in neoadjuvant/conversion therapy combined with radiotherapy for pancreatic cancer and discusses its potential role in modulating tumor biology and optimizing treatment strategies.

Objective:To explore whether perioperative oral probiotic therapy reduces infectious complications following pancreaticoduodenectomy (PD), aiming to obtain higher-level evidence for clinical practice.Methods:A total of 81 participants undergoing PD at the Department of Pancreatic and Metabolic Surgery, Nanjing Drum Tower Hospital & Affiliated Hospital of Medical School, Nanjing University, from May 2024 to December 2024 were enrolled in this single-center, prospective, randomized controlled trial. The participants were randomly divided into a probiotic treatment group and a control group (receiving conventional treatment without probiotics) using a random number method. The primary outcomes included the incidence of postoperative infectious complications and intra-abdominal infection, and the secondary outcomes were the recovery of gastrointestinal function, postoperative hospital stay, and duration and costs of antibiotic use. The hematological indicators including inflammation and immune markers on postoperative days (POD) 1, 3, 5, and 7 were also compared between these two groups.Results:Finally 72 cases (39 males and 33 females) were analyzed, with 36 patients in the probiotic treatment group and 36 patients in the control group. Compared to the control group, the probiotic treatment group showed statistically significant reductions in the incidence of infectious complications (33.3% vs. 66.7%, P=0.029), intra-abdominal infection (27.8% vs. 58.3%, P=0.030), and incidence of delayed gastric emptying (0 vs. 16.7%, P=0.033). Also, the probiotic treatment group exhibited significantly faster recovery in postoperative bowel movements and shorter time to defecation, liquid diet, and semi-liquid diet (all P<0.05). Additionally, the probiotic treatment group had significantly shorter hospital stay, reduced duration of antibiotic use, and lower antibiotic costs (all P<0.05). Finally, the probiotic treatment group had significantly higher lymphocyte counts on POD 1 ( P<0.05) and showed a significant downward trend in inflammatory markers such as interleukin-6 on PODs 3 and 5 and C-reactive protein on POD 7 (all P<0.05). Conclusions:Perioperative application of probiotic preparations in PD may reduce the incidence of postoperative infectious complications, especially intra-abdominal infection. Additionally, it can prevent delayed gastric emptying, promote the recovery of postoperative gastrointestinal function, shorten hospital stay, and reduce the use of antibiotics. These benefits may be related to the improvement of postoperative inflammatory status.

Pancreatic cancer is a highly aggressive malignancy with a poor prognosis,and surgical resection remains the only potentially curative treatment.However,since most patients are diagnosed at a locally advanced or metastatic stage,the feasibility of upfront surgery is limited.In recent years,neoadjuvant and conversion therapy have emerged as crucial strategies for borderline resectable and locally advanced pancreatic cancer,aiming to increase the R0 resection rate and improve survival outcomes.Studies have shown that FOLFIRINOX and gemcitabine plus nab-paclitaxel are commonly used neoadjuvant chemotherapy regimens,with the former being more suitable for patients with good performance status,while the latter is better tolerated across a broader patient population due to its lower toxicity.Additionally,radiotherapy,such as stereotactic body radiotherapy(SBRT),can enhance local tumor control,increase tumor cell eradication,and minimize damage to normal tissues,thereby optimizing overall treatment efficacy.Despite the significant advantages of this approach,challenges remain,including the management of toxic side effects and the optimization of treatment protocols.Future research will focus on personalized precision medicine,integrating genomic sequencing and radiomics to refine neoadjuvant/conversion therapy strategies and exploring the combination of chemotherapy,radiotherapy,immunotherapy,and targeted therapy to improve long-term survival in pancreatic cancer patients.This paper summarizes recent advancements in neoadjuvant/conversion therapy combined with radiotherapy for pancreatic cancer and discusses its potential role in modulating tumor biology and optimizing treatment strategies.

OBJECTIVE To explore the role of clinical pharmacists participating in the standardized perioperative nutritional management process for pancreaticoduodenectomy （PD） on improving postoperative recovery in patients. METHODS The clinical data of 100 patients undergoing PD in the Department of Biliary and Pancreatic Surgery， Drum Tower Hospital Affiliated to Nanjing University School of Medicine from November 2019 to February 2021 were analyzed retrospectively. According to the different perioperative nutrition management plans， they were divided into clinical pharmacist intervention group （n＝51， clinical pharmacists intervened according to the standardized nutrition management process） and control group （n＝49， clinical pharmacists only performed preoperative nutrition evaluation， and clinical physicians took nutrition support according to the patient’s condition）. The differences in postoperative recovery index， economic evaluation index， hospitalization length， postoperative complications， and postoperative enteral nutrition support route were compared between 2 groups. RESULTS The time of postoperative diet， the first postoperative ventilation， the first postoperative defecation， and postoperative drainage time of abdominal drain were significantly earlier in the clinical pharmacist intervention group than in the control group （P＜0.05）； the hospitalization cost， medication cost， nutritional support cost， parenteral nutrition cost， albumin preparation cost， and the length of postoperative hospitalization were significantly lower/shorter in the clinical pharmacist intervention group than in the control group （P＜0.05）； there was no statistically significant difference in the incidence of postoperative complications between the two groups （P＞0.05）； there was statistically significant difference in the perioperative enteral nutrition support pathways between two groups （P＜0.05）. CONCLUSIONS Clinical pharmacists’ participation in perioperative nutritional management for PD can significantly reduce hospitalization costs and nutritional support costs， improve patients’ perioperative nutritional status， and shorten hospital stays. wanglina668@163.com

Objective:To study the effect of first drainage failure on the prognosis of perihilar cholangiocarcinoma (PHCC).Methods:The clinical data of 68 patients with PHCC undergoing surgery in the Department of Pancreatic and Metabolic Surgery of Nanjing Drum Tower Hospital, Affiliated to the Medical School of Nanjing University, from April 2014 to December 2022 were retrospectively analyzed, including 46 males and 22 females, aged (63±9) (range, 39-80) years old. The patients were divided into two groups based on whether the first drainage was successful: successful group ( n=34) and failed group ( n=34). The patient's age, gender, first drainage, complications and other clinical data were collected. Patients were followed up by outpatient or telephone review. Kaplan-Meier method was used for survival analysis, and log-rank test was used for survival comparison. Results:Compared to the successful group, the drainage time [41(28, 52) d vs. 20(14, 28) d], the drainage tube adjustment rate [32.4%(11/34) vs. 0(0/34)], and the incidence of complications after drainage [88.2% (30/34) vs. 0(0/34)] were all increased in the failed group, with the adjustment rate of drainage position decreased [82.4%(28/34) vs. 100%(34/34)] (all P<0.05). Compared to the successful group, the incidence of abdominal infection was higher [70.6%(24/34) vs. 44.1%(15/34)] in the failed group ( P=0.027). The 5-year cumulative survival rates of the failed group and the successful group were 61.4% and 44.1%, respectively ( P>0.05). Conclusion:Compared to the patients of PHCC with first successful drainage, the risk of abdominal infection is increased when first drainage failed, while the incidence of postoperative complications, in-hospital mortality and long-term survival rate are comparable.

Objective To investigate the effects of sugammadex on postoperative pulmonary com-plications(PPCs)and postoperative recovery after thoracoscopic lung resection surgery.Methods A total of 263 patients scheduled for thoracoscopic lung resection surgery between November 2021 and July 2023,112 males and 151 females,aged 18-64 years,BMI 18.5-28.0 kg/m2,ASA physical status Ⅰ-Ⅲ,were randomly divided into three groups:the sugammadex group(group S,n=88),the neostigmine group(group N,n=87),and the control group(group C,n=88).The patient was sent to postanesthesia care unit(PACU)after operation,when the train of four(TOF)count reached 2,group S was given sugamma-dex 2 mg/kg,group N was given neostigmine 0.04 mg/kg+atropine 0.02 mg/kg,and group C was given equal volume of normal saline.The incidence of PPCs from the end of the surgery to the time of discharge was recorded.The time from the end of surgery to extubation,the time from drug administration to recovery of the train of four ratio(TOFr)to 0.9,the TOFr immediately after extubation,the length of stay in PACU,hypoxemia after extubation(SpO2＜90％)were recorded,and the incidence rate of postoperative residual neuromuscular block(PRNB)was calculated.The time of first getting out of the bed for activity,the number of total and effective compressions by the analgesia pump within 48 hours after surgery,the inci-dence of rescue analgesia,the clinical pulmonary infection score(CPIS),the numbers of postoperative nau-sea and vomiting(PONV),total drainage of the chest tube,duration of the chest tube insertion,and the length of postoperative hospital stay were recorded.Results Compared with group C,the incidence of PPCs,PRNB and hypoxemia after extubation were significantly decreased,time from the end of surgery to extubation,time from drug administration to recovery of TOFr to 0.9,the length of stay in PACU,and the first postoperatively out of bed activity time were significantly shortened,the TOFr immediately after extuba-tion was significantly increased,and CPIS was significantly decreased in group S(P＜0.05);the time from the end of surgery to extubation,time from drug administration to recovery of TOFr to 0.9,the length of stay in PACU were significantly shortened,the TOFr immediately after extubation was significantly in-creased,PRNB after extubation were significantly decreased in group N(P＜0.05).Compared with group N,the incidence of PRNB after extubation were significantly decreased,the time from the end of surgery to extubation,the time from drug administration to recovery of TOFr to 0.9,the length of stay in PACU,and the first postoperatively out of bed activity time were significantly shortened,the TOFr immediately after ex-tubation was significantly increased in group S(P＜0.05).There was no significant difference in other in-dexes between the three groups.Conclusion Sugammadex can rapidly antagonize the residual muscle re-laxation,decrease the rate of PPCs and PRNB,and promote rapid recovery of patients after thoracoscopic lung resection surgery.

Objective:To investigate the surgical situations and perioperative outcome of pancreaticoduodenectomy in Jiangsu Province and the influencing factors for postoperative 90-day mortality.Methods:The retrospective case-control study was conducted. The clinicopathological data of 2 886 patients who underwent pancreaticoduodenectomy in 21 large tertiary hospitals of Jiangsu Quality Control Center for Pancreatic Diseases, including The First Affiliated Hospital of Nanjing Medical University, from March 2021 to December 2022 were collected. There were 1 732 males and 1 154 females, aged 65(57,71)years. Under the framework of the Jiangsu Provincial Pancreatic Disease Quality Control Project, the Jiangsu Quality Control Center for Pancreatic Diseases adopted a multi-center registration research method to establish a provincial electronic database for pancrea-ticoduodenectomy. Observation indicators: (1) clinical characteristics; (2) intraoperative and post-operative conditions; (3) influencing factors for 90-day mortality after pancreaticoduodenectomy. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(IQR), and comparison between groups was conducted using the Mann-Whitney U test. Count data were expressed as absolute numbers or constituent ratio, and comparison between groups was conducted using the chi-square test, continuity correction chi-square test and Fisher exact probability. Maximal Youden index method was used to determine the cutoff value of continuous variables. Univariate analysis was performed using the corresponding statistical methods based on data types. Multivariate analysis was performed using the Logistic multiple regression model. Results:(1) Clinical characteristics. Of the 2 886 patients who underwent pancreaticoduodenectomy, there were 1 175 and 1 711 cases in 2021 and 2022, respectively. Of the 21 hospitals, 8 hospitals had an average annual surgical volume of <36 cases for pancreaticoduodenectomy, 10 hospitals had an average annual surgical volume of 36-119 cases, and 3 hospitals had an average annual surgical volume of ≥120 cases. There were 2 584 cases performed pancreaticoduodenectomy in thirteen hospitals with an average annual surgical volume of ≥36 cases, accounting for 89.536%(2 584/2 886)of the total cases. There were 1 357 cases performed pancrea-ticoduodenectomy in three hospitals with an average annual surgical volume of ≥120 cases, accounting for 47.020%(1 357/2 886) of the total cases. (2) Intraoperative and postoperative conditions. Of the 2 886 patients, the surgical approach was open surgery in 2 397 cases, minimally invasive surgery in 488 cases, and it is unknown in 1 case. The pylorus was preserved in 871 cases, not preserved in 1 952 cases, and it is unknown in 63 cases. Combined organ resection was performed in 305 cases (including vascular resection in 209 cases), not combined organ resection in 2 579 cases, and it is unknown in 2 cases. The operation time of 2 885 patients was 290(115)minutes, the volume of intra-operative blood loss of 2 882 patients was 240(250)mL, and the intraoperative blood transfusion rate of 2 880 patients was 27.153%(782/2 880). Of the 2 886 patients, the invasive treatment rate was 11.342%(327/2 883), the unplanned Intensive Care Unit (ICU) treatment rate was 3.087%(89/2 883), the reoperation rate was 1.590%(45/2 830), the duration of postoperative hospital stay was 17(11)days, the hospitalization mortality rate was 0.798%(23/2 882), and the failure rate of rescue data in 2 083 cases with severe complications was 6.529%(19/291). There were 2 477 patients receiving postoperative 90-day follow-up, with the 90-day mortality of 2.705%(67/2477). The total incidence rate of complication in 2 886 patients was 58.997%(1 423/2 412). The incidence rate of severe complication was 13.970%(291/2 083). The comprehensive complication index was 8.7(22.6) in 2 078 patients. (3) Influencing factors for 90-day mortality after pancreaticoduodenectomy. Results of multivariate analysis showed that age ≥ 70 years, postoperative invasive treatment, and unplanned ICU treatment were independent risk factors for 90-day mortality after pancreaticoduodenectomy ( odds ratio=2.403, 2.609, 16.141, 95% confidence interval as 1.281-4.510, 1.298-5.244, 7.119-36.596, P<0.05). Average annual surgical volume ≥36 cases in the hospital was an independent protective factor for 90-day mortality after pancreaticoduodenectomy ( odds ratio=0.368, 95% confidence interval as 0.168-0.808, P<0.05). Conclusions:Pancreaticoduodenectomy in Jiangsu Province is highly con-centrated in some hospitals, with a high incidence of postoperative complications, and the risk of postoperative 90-day mortality is significant higher than that of hospitallization mortality. Age ≥ 70 years, postoperative invasive treatment, and unplanned ICU treatment are independent risk factors for 90-day motality after pancreaticoduodenectomy, and average annual surgical volume ≥36 cases in the hospital is an independent protective factor.