Pancreatic cancer is currently recognized as one of the most malignant solid tumors， with a 5-year survival rate of 13% over a long period of time， and 80% of the patients have lost the opportunity for surgery at the time of confirmed diagnosis. In addition， the efficacy of conventional radiochemotherapy and targeted therapy is limited by high tumor heterogeneity and the complex immunosuppressive microenvironment. In recent years， mRNA vaccines have become a new focus of tumor immunotherapy due to their unique technical advantages. Based on non-integrating mRNA templates， mRNA vaccines enable precise encoding of tumor neoantigens， which are efficiently expressed in the host and can induce multifaceted immune responses. As for pancreatic cancer， current studies mainly focus on the development and optimization of tumor-associated antigen vaccines and tumor-specific antigen vaccines， as well as next-generation sequencing-guided neoantigen epitope optimization， innovative targeted delivery systems， and artificial intelligence-powered predictive models for immune response， thereby promoting the application of mRNA vaccines in the precise treatment of pancreatic cancer. Further studies should make breakthroughs in the targeted blockade of critical immunosuppressive molecules within the tumor microenvironment， the precise identification of tumor-specific antigenic epitopes， and the development of highly efficient vaccines， so as to bring new hopes for patients with pancreatic cancer.

With the development of surgery and technology, robot-assisted pancreatic surgery has gradually become a popular choice for surgeons, and is favored by patients and their families. As the first pancreatic disease treatment center in China to carry out robot-assisted pancreatic surgery, the author's team has unique experience and insight into robot-assisted pancreatic surgery. With the updating and domestication of surgical robots, the domestic multi-port robot-assisted surgical system has begun to be applied in clinical practice. The paper gave an overview of the development of domestic multi-port robotic surgical system in the clinical practice of pancreatic surgery.

Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant solid tumor of digestive system, which can affect the immune system. The abnormalities of distribution, percentage, function, and activity of immune cells in both peripheral circulation and tumor microenvironment (TME) are detected in patients with PDAC. T cells are the main lymphocytes that participate in cell-mediated immunity and exert anti-tumor effects. According to the function and the cluster of differentiation, T cells can be divided into different subsets, such as CD4+, CD8+, CD4+ CD25+, etc. The abnormalities of T cell subsets in the circulating immunity and TME of patients with PDAC may play an important role in cancer progress.

Pancreatic ductal adenocarcinoma (PDAC) is difficult to diagnose in its early stages. Most patients are diagnosed at a locally advanced or metastatic stage. Systemic therapy has become the key to improve survival. To bridge the differences in guidelines across Asian countries and address regional clinical practice needs, 14 leading experts in the Asia-Pacific region developed the “Asian Consensus on systemic therapy for pancreatic ductal adenocarcinoma” on the Delphi method. The consensus centers on 14 core recommendations (R1-R14) and proposes stratified management strategies based on disease stage. For resectable PDAC, adjuvant modified FOLFIRINOX (mFOLFIRINOX) is the preferred option, while for the patients with poor performance status gemcitabine plus capecitabine, S-1 monotherapy, and other regimens can be selected. For borderline resectable PDAC, neoadjuvant therapy is recommended, with GnP or FOLFIRINOX as the preferred regimens. For locally advanced PDAC, combination or monochemotherapy is selected based on their performance status. For metastatic PDAC, first-line options include GnP, NALIRIFOX, or mFOLFIRINOX, with second-line therapy the cross-use of gemcitabine-based and 5-FU-based regimens are emphasized. This consensus provides for the first time a comprehensive and standardized management framework for systemic therapy of PDAC in Asia, aiming to enhance regional homogeneity in clinical practice and improve patient outcomes. This article interpreted the consensus content with the goal of guiding clinical practice.

Post-pancreatectomy acute pancreatitis (PPAP) is a common complication following pancreatic surgery, characterized primarily by early postoperative local and systemic inflammatory responses. These responses can trigger a series of subsequent complications, significantly impacting patient’s clinical outcomes. In recent years, PPAP has been recognized as a distinct postoperative complication, and the International Study Group of Pancreatic Surgery (ISGPS) has proposed standardized definitions and grading criteria for it, which required a combination of postoperative enzyme elevation, imaging features, and changes in clinical management. This has garnered widespread attention within the field of pancreatic surgery. The occurrence of PPAP is closely related to microcirculatory disturbances. Clinically, it can manifest as self-limiting inflammation and is closely associated with pancreatic fistula development. In some cases, it may progress to necrotizing pancreatitis, potentially requiring surgical intervention. Current prevention and management strategies focus on intraoperative preservation of pancreatic blood supply, perioperative use of anti-inflammatory medications, and symptomatic supportive care. However, the diagnostic criteria, pathogenesis, and comprehensive management framework for PPAP still require further research and refinement.

Objective:To explore the safety and efficacy of Tumai domestic multi-port robot-assisted surgery system in the clinical application of distal pancreatectomy in pancreatic tumor patients.Methods:A prospective, single-center, single-arm exploratory study was conducted. A total of 20 patients who underwent robot-assisted pancreatic body-tail resection in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from March 2023 to November 2023 were enrolled, including 13 males and 7 females, aged (57.9±11.2) years. All the patients underwent robot-assisted distal pancreatectomy with Tumai multi-port surgical robot. Clinical data of complications, intraoperative blood loss, operative time, postoperative drainage tube retention time, and postoperative pathology were collected and statistically analyzed.Results:All the 20 patients underwent surgery successfully. Only 1 patient (5.0%) was diagnosed with pancreatic neuroendocrine tumor (G1 stage), and the rest were benign pancreatic tumors, including serous cystadenoma and mucinous cystadenoma. No instrument-related organ or blood vessel injury occurred, no intraoperative complications occurred. Of 7 patients (35.0%) had postoperative complications, including 3 infections, 3 abdominal effusion, and 1 hypokalemia. According to the Clavien-Dindo grading, all the cases were grade Ⅰ except 1 case with grade Ⅱ abdominal effusion. No serious complications above grade Ⅲ occurred. The intraoperative blood loss of the 20 patients was 100(20, 200) ml, the operative time was (125.7±76.9) min, and the postoperative retention time of drainage tube was (7.9±3.4) d.Conclusion:Tumai domestic multi-port robot-assisted surgery system has acceptable safety and efficacy in the clinical application of distal pancreatectomy.

Objective:To investigate pertinent risk factors for postoperative pancreatic fistula(POPF) after robotic-assisted distal pancreatectomy(RDP).Methods:This is a retrospective cohort study. Clinical data of 1 211 patients who underwent various methods of distal pancreatectomy at the Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,between January 2021 and December 2023 were retrospectively collected. Among the 1 211 patients,440 cases were in the robot-assisted group(173 males and 267 females),with an age( M(IQR)) of 55(29)years;720 cases were in the open surgery group (390 males and 330 females),with an age of 64(15)years;and 51 cases were in the laparoscopic group(17 males and 34 females),with an age of 56(25)years. These 440 patients who underwent RDP were divided into two cohorts based on the presence of clinically relevant pancreatic fistulas(grades B and C). Univariate and multivariate analysis were performed on 27 factors related to POPF. Univariate analysis methods included independent sample t-test,Mann-Whitney U test,and χ 2 test,while multivariate analysis utilized binary logistic regression. Results:After stratification by pathological type,there was no significant difference in the incidence of pancreatic fistula between the robot-assisted group and the open surgery group(benign tumor: χ 2=1.200, P=0.952;malignant tumor: χ 2=0.391, P=0.532). The surgical duration of the RDP group ( Z 1=15.113, P 1<0.01; Z 2=4.232, P 2<0.01) was significantly shorter than that of the open surgery and laparoscopic groups,so as the intraoperative blood loss ( Z 1=12.530, P 1<0.01; Z 2=2.550, P 2=0.032). Postoperative hospital stay in the RDP group was significantly shorter than that in the open surgery group ( Z 1=10.947, P 1<0.01), but not different from that in the laparoscopic group ( P 2>0.05). All 440 patients underwent successful surgery,of which there was only 1 case who underwent a conversion to open surgery. A total of 104 patients(23.6%) developed clinically relevant pancreatic fistulas,and no perioperative mortality was observed. Univariate analysis revealed that 6 factors were associated with POPF after RDP: gender( χ 2=12.048, P=0.001),history of smoking ( χ 2=6.327, P=0.012),history of alcohol consumption ( χ 2=17.597, P<0.01),manual pancreas division ( χ 2=9.839, P=0.002),early elevation of amylase in drainage fluid ( Z=5.187, P<0.01),and delayed gastric emptying ( χ 2=4.485, P=0.034). No statistically significant association with POPF was found for the remaining factors(all P>0.05).The cut-off value for the early amylase level in the drainage fluid was determined to be 7 719.5 IU/ml,with an area under curve of 0.676 determined by receiver operating characteristic curve analysis. Binary logistic regression analysis identified a history of alcohol consumption( P=0.002,95% CI: 0.112 to 0.623), manual pancreas division( P=0.001,95% CI:1.446 to 4.082),early amylase level of drainage fluid ≥7 719.5 IU/ml( P<0.01,95% CI:0.151 to 0.438),and delayed gastric emptying ( P=0.020, 95% CI: 1.131 to 4.233) as independent risk factors for POPF of RDP. Conclusion:Patients with pancreatic body and tail tumors who receive RDP therapy are at increased risk of developing a pancreatic fistula if they have a history of alcohol consumption,manual pancreas division,early elevation of amylase in drainage fluid to ≥7 719.5 IU/ml, or delayed gastric emptying.

Objective:To investigate pertinent risk factors for postoperative pancreatic fistula(POPF) after robotic-assisted distal pancreatectomy(RDP).Methods:This is a retrospective cohort study. Clinical data of 1 211 patients who underwent various methods of distal pancreatectomy at the Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,between January 2021 and December 2023 were retrospectively collected. Among the 1 211 patients,440 cases were in the robot-assisted group(173 males and 267 females),with an age( M(IQR)) of 55(29)years;720 cases were in the open surgery group (390 males and 330 females),with an age of 64(15)years;and 51 cases were in the laparoscopic group(17 males and 34 females),with an age of 56(25)years. These 440 patients who underwent RDP were divided into two cohorts based on the presence of clinically relevant pancreatic fistulas(grades B and C). Univariate and multivariate analysis were performed on 27 factors related to POPF. Univariate analysis methods included independent sample t-test,Mann-Whitney U test,and χ 2 test,while multivariate analysis utilized binary logistic regression. Results:After stratification by pathological type,there was no significant difference in the incidence of pancreatic fistula between the robot-assisted group and the open surgery group(benign tumor: χ 2=1.200, P=0.952;malignant tumor: χ 2=0.391, P=0.532). The surgical duration of the RDP group ( Z 1=15.113, P 1<0.01; Z 2=4.232, P 2<0.01) was significantly shorter than that of the open surgery and laparoscopic groups,so as the intraoperative blood loss ( Z 1=12.530, P 1<0.01; Z 2=2.550, P 2=0.032). Postoperative hospital stay in the RDP group was significantly shorter than that in the open surgery group ( Z 1=10.947, P 1<0.01), but not different from that in the laparoscopic group ( P 2>0.05). All 440 patients underwent successful surgery,of which there was only 1 case who underwent a conversion to open surgery. A total of 104 patients(23.6%) developed clinically relevant pancreatic fistulas,and no perioperative mortality was observed. Univariate analysis revealed that 6 factors were associated with POPF after RDP: gender( χ 2=12.048, P=0.001),history of smoking ( χ 2=6.327, P=0.012),history of alcohol consumption ( χ 2=17.597, P<0.01),manual pancreas division ( χ 2=9.839, P=0.002),early elevation of amylase in drainage fluid ( Z=5.187, P<0.01),and delayed gastric emptying ( χ 2=4.485, P=0.034). No statistically significant association with POPF was found for the remaining factors(all P>0.05).The cut-off value for the early amylase level in the drainage fluid was determined to be 7 719.5 IU/ml,with an area under curve of 0.676 determined by receiver operating characteristic curve analysis. Binary logistic regression analysis identified a history of alcohol consumption( P=0.002,95% CI: 0.112 to 0.623), manual pancreas division( P=0.001,95% CI:1.446 to 4.082),early amylase level of drainage fluid ≥7 719.5 IU/ml( P<0.01,95% CI:0.151 to 0.438),and delayed gastric emptying ( P=0.020, 95% CI: 1.131 to 4.233) as independent risk factors for POPF of RDP. Conclusion:Patients with pancreatic body and tail tumors who receive RDP therapy are at increased risk of developing a pancreatic fistula if they have a history of alcohol consumption,manual pancreas division,early elevation of amylase in drainage fluid to ≥7 719.5 IU/ml, or delayed gastric emptying.

Due to the characteristics of the insidious onset,difficult early diagnosis and high malignancy of pancrea-tic cancer,only a minority of patients still have the chance of surgical resection at the time of diagnosis.In recent years,chemotherapy-based preoperative neoadjuvant therapy has been increasingly applied to pancreatic cancer without distant metastases to help achieve tumor downstaging,increase RO resection rate and improve patient survival.A large number of clinical trials have proven the advantages of neoadjuvant therapy for pancreatic cancer,but there are still many issues to be gradually addressed by further research to reach a consensus.

Objective:To investigate the prognosis of robotic pancreatoduodenectomy after the learning curve and open pancreatoduodenectomy for pancreatic cancer.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 396 patients who underwent curative pancreatoduodenectomy for pancreatic duct adenocar-cinoma in Ruijin Hospital of Shanghai Jiaotong University School of Medicine from January 2017 to December 2018 were collected. There were 244 males and 152 females, aged 64(range, 36?92)years. Of 396 patients, 86 cases undergoing robotic pancreatoduodenectomy were divided into robotic group, 310 cases undergoing open pancreatoduodenectomy were divided into open group. Observa-tion indicators: (1) propensity score matching and comparison of general data between the two groups after matching; (2) follow-up and survival analysis. Follow-up was conducted by telephone interview or outpatient examinations including tumor markers and abdominal imaging examina-tions to detect survival of patients up to March 2022. Overall survival was defined as the time from the surgery date to death or the last follow-up. Disease-free survival was defined as the time from the surgery date to tumor recurrence or the last follow-up. The propensity score matching was conducted by 1∶1 matching using the nearest neighbor method. Normality of measurement data was examined using the Shapiro-Wilk test. Measurement data with skewed distribution were described as M(range), and comparison between groups was analyzed using the Mann-Whitney rank-sum test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test. Kaplan-Meier method was used to calculate survival rates and draw survival curves, and Log-Rank test was used for survival analysis. An intent-to-treat analysis was performed in this study, patients who were converted to laparotomy from robotic surgery were still divided into the robotic group. Results:(1) Propensity score matching and comparison of general data between the two groups after matching: 164 of 396 patients had successful matching, including 82 cases in robotic group and open group, respectively. Before propensity score matching, the body mass index, cases in stage T1, T2, T3, T4, cases in N0, N1, N2 were 23.4(range, 21.4?25.3)kg/m 2,24, 41, 10, 11, 52, 27, 7 for the robotic group, versus 22.4(range,20.3?23.9)kg/m 2,57, 144, 22, 87, 131, 132, 47 for the open group, showing significant differences in the above indicators between the two groups ( Z=3.01, 2.63, 3.03, P<0.05). After propensity score matching, cases of males, age, body mass index, cases with American Society of Anesthesiologists (ASA) score as 1, 2, 3, CA19-9, cases with preoperative biliary drainage, cases with portal vein resection, cases with pancreatic resection margin <1 mm, cases in stage T1, T2, T3, T4, cases in stage N0, N1, N2, cases with nerve invasion, cases with tumor differentiation as high-medium differentiation, medium-low differentiation, low differentiation, cases with adjuvant chemotherapy were 51, 65(range, 59?69)years, 23.0(range, 21.0?25.2)kg/m 2, 32, 41, 9, 160.4(range, 46.7?377.2)U/mL, 21, 9, 8, 21, 40, 10, 11, 48, 27, 7, 76, 26, 47, 9, 53 for the robotic group, versus 58, 65(range, 58?69)years, 23.3(range, 21.4?25.3)kg/m 2, 35, 39, 8, 172.0(range, 69.7?402.9)U/mL, 26, 9, 10, 24, 40, 7, 11, 49, 28, 5, 76, 22, 49, 11, 57 for the open group, showing no significant difference in the above indicators between the two groups ( χ2=1.34, Z=0.18, 0.34, 0.49, 0.51, χ2=0.75, 0.00,0.25, Z=0.59, 0.27, χ2=0.00, Z=0.76, χ2=0.44, P>0.05). (2) Follow-up and survival analysis: after propensity score matching, 164 patients were followed up for 54(range, 1?67)months. The follow-up time of patients was 55(range, 51?59)months for the robotic group, versus 54(range, 50?58)months for the open group, respectively, showing no significant difference between the two groups ( Z=0.48, P>0.05). During the follow-up, the 1-year overall survival rate, 3-year overall survival rate, the median survival time, 1-year disease-free survival rate, 3-year disease-free survival rate, the median disease-free survival time, tumor recurrence rate, cases with recurrence pattern as local recurrence, liver recurrence, other distant recurrence, local and distant recurrence were 81.7%, 39.0%, 27 months(95% confidence interval as 19?33 months), 61.0%, 34.2%, 15 months(95% confidence interval as 12?18 months), 54.9%(45/82), 12, 16, 9, 8 for the robotic group. The above indicators were 79.3%, 36.0%, 24 months(95% confidence interval as 19?31 months), 59.8%, 27.5%, 15 months(95% confidence interval as 10?20 months), 58.5% (48/82), 10, 22, 6, 10 for the open group. There was no significant difference in overall survival or disease-free survival between the two groups ( χ2=0.39, 0.47, P>0.05). There was no significant difference in tumor recurrence rate or tumor recurrence site between the two groups either ( χ2=0.22, 1.86, P>0.05). Conclusion:After the learning curve, robotic pancreato-duodenectomy has non-inferior prognosis compared with open pancreatoduodenectomy.