Chinese Journal of Surgery dates back to 1951, a time when pancreatic surgery was emerging in China. Due to the deep anatomical location and complex physiological functions of the pancreas, pancreatic diseases are often severe and challenging to treat. Since its inception, Chinese Journal of Surgery has comprehensively documented the evolution of pancreatic surgery in China from its nascent stages to robust maturation, while actively propelling the advancement of this discipline domestically. This article reviews the 75-year journey of Chinese pancreatic surgeons who, through relentless dedication and exploration, have progressed from following international peers to standing shoulder-to-shoulder and even leading in the management of pancreatic diseases, including pancreatic cancer, severe acute pancreatitis, pancreatic neuroendocrine tumors, and chronic pancreatitis. It aims to inspire colleagues to seize opportunities, pursue innovation, and sustain the vitality and growth of pancreatic surgery in China.

Chinese Journal of Surgery dates back to 1951, a time when pancreatic surgery was emerging in China. Due to the deep anatomical location and complex physiological functions of the pancreas, pancreatic diseases are often severe and challenging to treat. Since its inception, Chinese Journal of Surgery has comprehensively documented the evolution of pancreatic surgery in China from its nascent stages to robust maturation, while actively propelling the advancement of this discipline domestically. This article reviews the 75-year journey of Chinese pancreatic surgeons who, through relentless dedication and exploration, have progressed from following international peers to standing shoulder-to-shoulder and even leading in the management of pancreatic diseases, including pancreatic cancer, severe acute pancreatitis, pancreatic neuroendocrine tumors, and chronic pancreatitis. It aims to inspire colleagues to seize opportunities, pursue innovation, and sustain the vitality and growth of pancreatic surgery in China.

Pancreatic cystic neoplasm (PCN) has multiple pathological types, with an increasing incidence year by year. PCN exhibits strong heterogeneity, and the risk of malignancy and malignant transformation varies significantly among different pathological types. Additionally, pancreatic resection carries high surgical risks, so multiple factors must be considered when making treatment decisions for PCN. Among various pathological types of PCN, intraductal papillary mucinous tumors, mucinous cystic neoplasms, and serous cystic neoplasms share similar imaging characteristics and relatively high incidence rates, but their treatment strategies differ markedly. This article, based on recommendations from domestic and international guidelines, literature reviews, and the author′s clinical experience, offers insights and solutions to the challenges in diagnosing and treating these three types of PCN. It emphasizes that it is essential to diagnose as accurately as possible through existing examination methods and MDT discussions; for patients who cannot be definitively diagnosed and have no risk factors, a close follow-up strategy should be adopted, and surgery should not be performed arbitrarily.

Objective:This multicenter retrospective study aimed to analyze the clinicopathological features of duodenal adenocarcinoma (DA) and identify prognostic factors for postoperative survival.Methods:Demographic characteristics, clinicopathological features, treatment outcomes and survival of DA patients undergoing surgical treatment at 18 Chinese medical centers from January 2012 to December 2023 were retrospectively analyzed.Results:Among the 2 056 DA patients included, 46.8% (963) had extra-ampullary DA (EA-DA), and 53.2% (1 093) had peri-ampullary DA (PA-DA). The 1-, 3-, and 5-year overall survival (OS) rates for patients who underwent radical surgery were 93.2%, 71.0%, and 57.2%, respectively. The median overall survival was 76 months, and the median progression-free survival (PFS) was 65 months. No differences in survival were observed between the laparotomy group and minimally invasive surgery (MIS) group either before or after propensity score matching (OS: 76 vs. 75 months before PSM, P=0.986; OS: 75 vs. 75 months after PSM, P=0.602). Furthermore, there were no significant differences between-group in operation time and postoperative complications ( P＞0.05). The MIS group experienced less intraoperative blood loss and shorter hospital stays. The multivariate Cox regression analysis revealed that advanced age ( HR=1.43,95% CI:1.18-1.73), elevated carbohydrate antigen 19-9 levels ( HR=1.24,95% CI:1.02-1.51), perineural invasion ( HR=1.44,95% CI:1.14-1.81), vascular invasion ( HR=1.35,95% CI:1.07-1.71), advanced T stage (T3-4 vs. T1-2: HR=1.86,95% CI:1.49-2.31), regional lymph node metastasis ( HR=1.93,95% CI:1.58-2.36), preoperative biliary drainage ( HR=1.26,95% CI:1.04-1.53), intraoperative blood loss ( HR=1.34,95% CI:1.11-1.62), clinically significant postoperative pancreatic fistulas ( HR=1.53,95% CI:1.12-2.09), and postoperative hemorrhage ( HR=1.62,95% CI:1.14-2.29) were independent risk factors for poor prognosis after surgery (all P＜0.05). Conclusions:Radical surgery is associated with favorable overall survival among DA patients, and no difference in survival is observed between EA-DA and PA-DA patients. MIS is a reliable alternative for DA treatment.

Objective:This multicenter retrospective study aimed to analyze the clinicopathological features of duodenal adenocarcinoma (DA) and identify prognostic factors for postoperative survival.Methods:Demographic characteristics, clinicopathological features, treatment outcomes and survival of DA patients undergoing surgical treatment at 18 Chinese medical centers from January 2012 to December 2023 were retrospectively analyzed.Results:Among the 2 056 DA patients included, 46.8% (963) had extra-ampullary DA (EA-DA), and 53.2% (1 093) had peri-ampullary DA (PA-DA). The 1-, 3-, and 5-year overall survival (OS) rates for patients who underwent radical surgery were 93.2%, 71.0%, and 57.2%, respectively. The median overall survival was 76 months, and the median progression-free survival (PFS) was 65 months. No differences in survival were observed between the laparotomy group and minimally invasive surgery (MIS) group either before or after propensity score matching (OS: 76 vs. 75 months before PSM, P=0.986; OS: 75 vs. 75 months after PSM, P=0.602). Furthermore, there were no significant differences between-group in operation time and postoperative complications ( P＞0.05). The MIS group experienced less intraoperative blood loss and shorter hospital stays. The multivariate Cox regression analysis revealed that advanced age ( HR=1.43,95% CI:1.18-1.73), elevated carbohydrate antigen 19-9 levels ( HR=1.24,95% CI:1.02-1.51), perineural invasion ( HR=1.44,95% CI:1.14-1.81), vascular invasion ( HR=1.35,95% CI:1.07-1.71), advanced T stage (T3-4 vs. T1-2: HR=1.86,95% CI:1.49-2.31), regional lymph node metastasis ( HR=1.93,95% CI:1.58-2.36), preoperative biliary drainage ( HR=1.26,95% CI:1.04-1.53), intraoperative blood loss ( HR=1.34,95% CI:1.11-1.62), clinically significant postoperative pancreatic fistulas ( HR=1.53,95% CI:1.12-2.09), and postoperative hemorrhage ( HR=1.62,95% CI:1.14-2.29) were independent risk factors for poor prognosis after surgery (all P＜0.05). Conclusions:Radical surgery is associated with favorable overall survival among DA patients, and no difference in survival is observed between EA-DA and PA-DA patients. MIS is a reliable alternative for DA treatment.

Surgical resection remains the only potentially curative treatment for pancreatic cancer to date.However,pancreatic cancer surgery is also one of procedures carrying the highest risks among all malignant tumor surgeries,in terms of perioperative complications and long-term prognosis,posing a significant challenge to surgeons.In recent years,the centralization of pancreatic surgery in high-volume centers,advancements in surgical techniques,and improvements in perioperative management of pancreatic cancer resection have significantly reduced the incidence of perioperative complications and mortality.In addition,surgeons have begun exploring minimally invasive approaches,such as laparoscopic and robot-assisted surgeries,for radical resection of pancreatic cancer,aiming to reduce surgical trauma,accelerate patient recovery,and improve quality of life.The technical feasibility of minimally invasive approaches has been validated in multiple studies through comparisons of the perioperative safety of minimally invasive pancreatic resection with that of conventional open surgery.However,research on the long-term oncologic prognosis of minimally invasive surgery for pancreatic cancer remains limited,and controversy persists regarding the suitability of minimally invasive methods for radical resection of pancreatic cancer.Therefore,surgeons should adhere to the fundamental principles of surgical oncology,including en bloc resection and the no-touch isolation technique,when they perform minimally invasive pancreatic cancer surgery.Additionally,more comparative studies are warranted to determine whether minimally invasive pancreatic cancer surgery offers survival benefits in the long term.This review aims to provide an objective evaluation of the role of minimally invasive techniques in radical resection of pancreatic cancer,while cautioning against compromising the principles of surgical oncology in the pursuit of minimally invasive approaches.

Pancreatic cystic neoplasm (PCN) has multiple pathological types, with an increasing incidence year by year. PCN exhibits strong heterogeneity, and the risk of malignancy and malignant transformation varies significantly among different pathological types. Additionally, pancreatic resection carries high surgical risks, so multiple factors must be considered when making treatment decisions for PCN. Among various pathological types of PCN, intraductal papillary mucinous tumors, mucinous cystic neoplasms, and serous cystic neoplasms share similar imaging characteristics and relatively high incidence rates, but their treatment strategies differ markedly. This article, based on recommendations from domestic and international guidelines, literature reviews, and the author′s clinical experience, offers insights and solutions to the challenges in diagnosing and treating these three types of PCN. It emphasizes that it is essential to diagnose as accurately as possible through existing examination methods and MDT discussions; for patients who cannot be definitively diagnosed and have no risk factors, a close follow-up strategy should be adopted, and surgery should not be performed arbitrarily.

Objective:To construct an ensemble machine learning model for predicting the occurrence of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy and evaluate its application value.Methods:This is a research on predictive model. Clinical data of 421 patients undergoing pancreaticoduodenectomy in the Department of Pancreatic Surgery,Union Hospital, Tongji Medical College,Huazhong University of Science and Technology from June 2020 to May 2023 were retrospectively collected. There were 241 males (57.2%) and 180 females (42.8%) with an age of (59.7±11.0)years (range: 12 to 85 years).The research objects were divided into training set (315 cases) and test set (106 cases) by stratified random sampling in the ratio of 3∶1. Recursive feature elimination is used to screen features,nine machine learning algorithms are used to model,three groups of models with better fitting ability are selected,and the ensemble model was constructed by Stacking algorithm for model fusion. The model performance was evaluated by various indexes,and the interpretability of the optimal model was analyzed by Shapley Additive Explanations(SHAP) method. The patients in the test set were divided into different risk groups according to the prediction probability (P) of the alternative pancreatic fistula risk score system (a-FRS). The a-FRS score was validated and the predictive efficacy of the model was compared.Results:Among 421 patients,CR-POPF occurred in 84 cases (20.0%). In the test set,the Stacking ensemble model performs best,with the area under the curve (AUC) of the subject′s work characteristic curve being 0.823,the accuracy being 0.83,the F1 score being 0.63,and the Brier score being 0.097. SHAP summary map showed that the top 9 factors affecting CR-POPF after pancreaticoduodenectomy were pancreatic duct diameter,CT value ratio,postoperative serum amylase,IL-6,body mass index,operative time,albumin difference before and after surgery,procalcitonin and IL-10. The effects of each feature on the occurrence of CR-POPF after pancreaticoduodenectomy showed a complex nonlinear relationship. The risk of CR-POPF increased when pancreatic duct diameter<3.5 mm,CT value ratio<0.95,postoperative serum amylase concentration>150 U/L,IL-6 level>280 ng/L,operative time>350 minutes,and albumin decreased by more than 10 g/L. The AUC of a-FRS in the test set was 0.668,and the prediction performance of a-FRS was lower than that of the Stacking ensemble machine learning model.Conclusion:The ensemble machine learning model constructed in this study can predict the occurrence of CR-POPF after pancreaticoduodenectomy,and has the potential to be a tool for personalized diagnosis and treatment after pancreaticoduodenectomy.

Objective:To construct an ensemble machine learning model for predicting the occurrence of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy and evaluate its application value.Methods:This is a research on predictive model. Clinical data of 421 patients undergoing pancreaticoduodenectomy in the Department of Pancreatic Surgery,Union Hospital, Tongji Medical College,Huazhong University of Science and Technology from June 2020 to May 2023 were retrospectively collected. There were 241 males (57.2%) and 180 females (42.8%) with an age of (59.7±11.0)years (range: 12 to 85 years).The research objects were divided into training set (315 cases) and test set (106 cases) by stratified random sampling in the ratio of 3∶1. Recursive feature elimination is used to screen features,nine machine learning algorithms are used to model,three groups of models with better fitting ability are selected,and the ensemble model was constructed by Stacking algorithm for model fusion. The model performance was evaluated by various indexes,and the interpretability of the optimal model was analyzed by Shapley Additive Explanations(SHAP) method. The patients in the test set were divided into different risk groups according to the prediction probability (P) of the alternative pancreatic fistula risk score system (a-FRS). The a-FRS score was validated and the predictive efficacy of the model was compared.Results:Among 421 patients,CR-POPF occurred in 84 cases (20.0%). In the test set,the Stacking ensemble model performs best,with the area under the curve (AUC) of the subject′s work characteristic curve being 0.823,the accuracy being 0.83,the F1 score being 0.63,and the Brier score being 0.097. SHAP summary map showed that the top 9 factors affecting CR-POPF after pancreaticoduodenectomy were pancreatic duct diameter,CT value ratio,postoperative serum amylase,IL-6,body mass index,operative time,albumin difference before and after surgery,procalcitonin and IL-10. The effects of each feature on the occurrence of CR-POPF after pancreaticoduodenectomy showed a complex nonlinear relationship. The risk of CR-POPF increased when pancreatic duct diameter<3.5 mm,CT value ratio<0.95,postoperative serum amylase concentration>150 U/L,IL-6 level>280 ng/L,operative time>350 minutes,and albumin decreased by more than 10 g/L. The AUC of a-FRS in the test set was 0.668,and the prediction performance of a-FRS was lower than that of the Stacking ensemble machine learning model.Conclusion:The ensemble machine learning model constructed in this study can predict the occurrence of CR-POPF after pancreaticoduodenectomy,and has the potential to be a tool for personalized diagnosis and treatment after pancreaticoduodenectomy.

Objective: To explorethe proper protective measures for pancreaticdiseases treatment during theoutbreak of 2019 coronavirus disease(COVID-19). Method: Clinical data of four cases of patients that suffered COVID-19from February 2^nd, 2020 to February 9^th, 2020 in pancreatic surgery were reviewed.After the first patientscuffednosocomial infection of COVID-19, the general protective measures in our department wereupdated.Only one patient was admitted to each room alone, with no more than one caregiver.The body temperature of care givers was measuredtwice a day.Primary protections were applied to all staff.The floor was sterilized using disinfectant with an effective chlorine concentration of 1000 mg/L.The protective measures for interventional procedures were as follow.Primary protection was applied to the operators ofcentral venipuncture catheter, percutaneous abdominal/pleural drainage, percutaneous retroperitoneal drainage, percutaneous transhepatic cholangial drainage and other surgical procedures with local anesthesiaand epidural anesthesia.Secondary protection was applied to the operators of endoscopic retrograde cholangiopancreatography and surgical procedures with general anesthesia. Results: During Feb 2^nd, 2020 to Feb 9^th, 2020, four patients in our department were diagnosed with COVID-19, of which one was died of COVID-19, two were cured, and one is still in hospital for COVID-19.After the update ofprotective measures in our department, no more nosocomial infection of COVID-19occurred.Two central venipuncture catheter, three percutaneous abdominal/pleural drainage, one percutaneous retroperitoneal drainage, one percuteneous transhepatic cholecyst drainage and one open surgery with general anesthesia were performed with no infection of operators. Conclusions The caregivers of patients are potential infection source of COVID-19.Enhanced protective measures including the management measures of caregivers can decrease the risk of nosocomial infection of COVID-19.