Objective To explore the prognostic factors of new-onset diabetes mellitus(NODM)in patients with pancreatic cystic tumor after distal pancreatectomy(DP).Methods Between January 2010 and December 2019,92 patients with cystic pancreatic tumors in our hospital underwent laparoscopic DP.According to the inclusion and exclusion criteria,a total of 74 cases were included and divided into NODM group or normal glucose metabolism group based on whether postoperative NODM occurred.A univariate analysis was used to evaluate the prognostic factors of laparoscopic DP for pancreatic cystic tumors.P<0.05 was considered statistically significant,OR>4 was considered as a potential prognostic factor of clinical significance for NODM.Results NODM was diagnosed in26 cases(35.1%),with a median diagnosis time of 9 months(range,3-56 months)after surgery.Univariate analysis showed that transecting pancreas in the neck(OR = 11.000,P = 0.000),BMI≥25.0(OR = 4.333,P = 0.007),and family history of diabetes mellitus(OR =5.000,P =0.004)were prognostic factors of postoperative NODM.Conclusions When performing DP for pancreatic cystic tumors,it is advisable to preserve as much pancreatic tissue as possible and avoid cutting off the pancreas in the neck.Precise postoperative strategy of glucose metabolism surveillance for patients with BMI≥25.0 and family history of diabetes mellitus should be promoted.

The prognosis of pancreatic cancer is unfavorable. Radical operations remain the sole potential cure method, but early vascular invasion is a significant limiting factor for successful resection. For patients with borderline resectable and locally advanced pancreatic cancer, a radical operation combining vascular resection can enhance the rate of negative surgical margins and improve survival outcomes. Currently, the guidelines recommend venectomy while the arterial treatment is still controversial. This article discusses the contemporary concerns regarding vascular invasion in pancreatic surgery and the corresponding strategies for treatment.

Objective To preliminarily analyze the efficacy of laparoscopic surgery versus open surgery in patients with intrahepatic cholangiocarcinoma(ICC).Methods A retrospective analysis was conducted on 84 patients with ICC who underwent surgical resection from September 2010 to March 2023,including 45 cases in the laparoscopic surgery group and 39 in the open surgery group.By using propensity score matching,34 matched pairs were successfully identified.The study compared intraoperative blood loss,proportion of achieving≥6 lymph nodes dissection,R0 resection rate,complication,postoperative hospital stay,survival,and recurrence between the two groups.Results In the laparoscopic group,intraoperative blood loss was significantly less than that in the open surgery group(median:250 ml vs.750 ml,Z=-3.406,P=0.001).The proportion of achieving≥6 lymph node dissection in the former was lower than that in the latter,but the difference was not statistically significant(5.9%vs.17.6%,χ2=1.275,P=0.259).There was no statistical difference in R0 resection rate between the laparoscopic group and the open surgery group[88.2%(30/34)vs.82.4%(28/34),χ2=0.469,P=0.493].The complication rate in the laparoscopic group was 17.6%(6/34),significantly lower than 47.1%(16/34)in the open surgery group(χ2=6.719,P=0.010);however,the rate of severe complication was the same in both groups at 2.9%(χ2=0.000,P=1.000).Laparoscopic surgery significantly shortened the postoperative hospital stay(median:7 d vs.10 d,Z=-3.021,P=0.003).The median overall survival in the laparoscopic group was 60.6 months,significantly longer than 15.9 months in the open surgery group(log-rank χ2=5.788,P=0.016).The median recurrence-free survival was 26.4 months in the laparoscopic group,significantly longer than 7.6 months in the open surgery group(log-rank χ2=4.532,P=0.033).Conclusions Compared to open surgery,laparoscopic surgery for ICC offers advantages such as less blood loss,lower complication rate,shorter postoperative hospital stay and longer survival.It achieves comparable R0 resection rate and adequate lymph node dissection.

Objective:To explore the expression of PD-L1 and B7-H3 in intrahepatic cholangiocarcinoma (ICC) and their relationship with the prognosis after surgery.Methods:Clinicopathological data of 63 ICC patients undergoing surgery at the Department of General Surgery, Peking University Third Hospital, from Sep 2016 to Mar 2023 were retrospectively analyzed.Results:PD-L1 and B7-H3 are highly expressed in 41.3% and 60.3% of ICC patients, respectively, and their expression levels were positively correlated with each other( P=0.005). High PD-L1 expression is significantly associated with poor tumor differentiation ( P=0.014), while high B7-H3 expression is significantly related to lymph node metastasis ( P=0.035). In patients with high co-expression of PD-L1 and B7-H3, the overall survival ( P=0.031) and recurrence-free survival ( P=0.031) were significantly decreased. High co-expression of PD-L1 and B7-H3 is an independent risk factor for recurrence in ICC ( HR=3.998, 95% CI: 1.211-13.198; P=0.023). Conclusions:ICC patients with high expression of both PD-L1 and B7-H3 have a poor prognosis. Using both as the combined biomarker significantly improves the prediction of long-term survival after surgery, compared to using either one alone.

Pancreatic fistula is one of the most important complications after pancreatic surgery. The International Study Group on Pancreatic Fistula proposed the definition and classification of postoperative pancreatic fistula (POPF) in 2005 firstly, which has promoted the development of pancreatic surgery research. And the International Study Group on Pancreatic Surgery modified the POPF standard in 2016 and paid more attention to clinical relevance. The POPF is often used to evaluate anastomotic methods. However, this grading version is based on clinical outcomes, which more represents the comprehensive treatment effect than reflects the quality of pancreaticojejunostomy. Using the current POPF grading criteria for the purpose of improving anastomosis methods is not very accurate, so an indicator that only reflects anastomosis′ quality is needed for the comparison of various surgical methods. To avoid the influence of non-reconstruction elements on the incidence and degree of POPF, this research team prefer the total drainage fluid amylase(DFA)or the duration of high DFA. And in this way, the comparation among different anastomotic operations could be specific and objective, which further helps to find out an ideal method for pancreatic digestive tract reconstruction.

Objective:To investigate the clinical effects of neoadjuvant chemotherapy on different types of borderline resectable pancreatic cancer.Methods:The clinical data of 46 patients with borderline resectable pancreatic cancer admitted to Peking University Third Hospital from Jan 2017 to Aug 2021 were retrospectively analyzed, including 26 with arterial borderline resectable pancreatic cancer (ABRPC) and 20 with venous borderline resectable pancreatic cancer (VBRPC). Eighteen patients of VBRPC and 15 patients of ABRPC were then successfully received surgical resection.Results:After neoadjuvant chemotherapy, CA19-9 levels decreased significantly ( P<0.05), while other indicators were not statistically different ( P>0.05). Compared with the non-surgical group, the diameter of the tumour was significantly reduced after neoadjuvant chemotherapy ( P<0.05). The surgical resection rate of 90.0% in the VBRPC group was higher than that of 57.7% in the ABRPC group ( P=0.037). Conclusions:Patients with significantly tumour progress after neoadjuvant chemotherapy are difficult to benefit from neoadjuvant chemotherapy; Venous borderline resectable pancreatic cancer patients had a higher surgical resection rate than those with ABRPC after neoadjuvant chemotherapy.

There are significant differences between eastern and western guidelines for the treatment of hepatocellular carcinoma, and the treatment of advanced liver cancer is still a major challenge. With the development of systematic therapy for hepatocellular carcinoma, these drugs have gradually moved from clinical trials to clinical practice, from second-line to first-line treatment. Up to now, we have entered the era of targeted therapy combined with immunotherapy, which provided us with new strategies for adjuvant; neoadjuvant and conversion therapy in the treatment of hepatocellular carcinoma. Hepatocellular carcinoma has a very high recurrence rate after operation. At present, there is no effective postoperative adjuvant therapy strategy to reduce recurrence. With the promoting of clinical trials, application of adjuvant therapy in selected patients based on the risk of recurrence may be the future research directions. For neoadjuvant therapy and conversion therapy, the most urgent issue may be the controversial criteria. Through further basic and clinical research, precise and individualized targeted therapy and immunotherapy for hepatocellular carcinoma is the future development direction.

Pancreatic fistula is a common complication after distal pancreatectomy, and its occurrence will increase the risk of other postoperative complications and even lead to the death of patients. Although the grading diagnosis of postoperative pancreatic fistula has been widely applied, the diagnosis of grade B pancreatic fistula is relatively broad. Further stratification is needed to assist in the disease severity assessment and treatment of postoperative patients. In terms of the prevention of pancreatic fistula after distal pancreatectomy, there are still controversies in the aspects of intraoperative operation, early postoperative nutritional support, the timing of drainage tube removal, and the use of somatostatin analogs. Therefore, this article will discuss many problems including grading and prevention of pancreatic fistula after distal pancreatectomy, to provide a more persuasive clinical basis.

Objective:To study the detection rates of using different MRI sequences and enhanced CT in colorectal cancer liver metastasis (CRLM).Methods:The imaging data of CRLM patients who were treated at Peking University Third Hospital from March 2018 to September 2021 were retrospectively analyzed. Sixty-six CRLM lesions with a maximum diameter ≤10 mm were selected. Different MRI sequences such as T 1 weighted imaging (T 1WI), T 2 weighted imaging (T 2WI), diffusion weighted imaging (DWI), dynamic enhanced phase of MRI (MR-Dyn), gadolinium-etoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA), enhanced hepatobiliary phase of MRI (HBP) and CT enhancement phase (CT-Dyn) were reviewed independently to determine whether the target lesions were detected. The pathological results were used as the gold standard. Paired chi-square test was used to compare the detection rate of CRLM in each group. Results:Among the 66 liver metastases, 15, 31, 55, 21, 56 and 20 were detected by T 1WI, T 2WI, DWI, MR-Dyn, HBP and CT-Dyn, respectively. Their detection rates were 22.7%, 47.0%, 83.3%, 31.8%, 84.8% and 30.3%, respectively. The detection rates of HBP and DWI were higher than those of T 2WI, MR-Dyn, CT-Dyn and T 1WI, respectively (all P<0.05). The detection rate of T 2WI was higher than that of MR-Dyn, CT-Dyn and T 1WI (all P<0.05). The detection efficiencies of non-contrast MRI and Gd-EOB-DTPA enhanced MRI for CRLM were highly consistent ( Kappa=0.745). Conclusions:The detection rates of HBP, DWI and T 2WI for CRLM were high. Non-contrast MRI could replace Gd-EOB-DTPA enhanced MRI for detection of large CRLM.

The increasing incidence and early diagnosis of benign and low grade malignant tumor have presented new challenge to surgeons. Nowadays the safety of pancreatic surgery are warranted due to the progress of surgical techniques, resulting in the expansion of surgical indications. The long survival time post-operation of benign or low grade malignant tumors makes the preservation of endocrine and exocrine function of pancreas more and more important, and the parenchyma-preserving pancreatectomy has been increasing used at experienced medical center, including enucleation, central pancreatectomy and duodenum preserving pancreatic head resection. Compared with pancreaticoduodenectomy and distal pancreatectomy, significantly less patients suffered from endocrine and exocrine insufficiency after local resection of pancreas. More complications was observed after enucleation and duodenum preserving pancreatic head resection, mostly grade A pancreatic fistula, with low rate of mortality. Central pancreatectomy was associated with significantly more severe complications, compared with distal pancreatectomy. Laparoscopic or robotic local resection of pancreas are minimally invasive, and more suitable for the protection of main pancreatic duct with amplifying visions, and is more suitable for local resection of the pancreas than open surgery.