Patients with pancreatic surgery have a high incidence of preoperative malnutri-tion, large surgical trauma, and many postoperative complications. The practice of enhanced recovery after surgery is difficult. After nearly 20 years of development, the concept of enhanced recovery after surgery (ERAS) has formed mature guidelines and consensus in pancreatic surgery. However, its application is faced with problems such as large central differences, low level of evidence-based, and insufficient completion of rehabilitation processes. The growth of publications in journals on related topics has stagnated, and the research heat has a trend of ebbing. Based on the literature at home and abroad, the authors analyze the bottleneck of application of enhanced recovery after surgery in pancreatic cancer from the aspects of process management, pre-rehabilitation and nutrition management, and look forward to the future research direction.

On the occasion of the 110th Anniversary of the establishment of the Chinese Medical Association, the third conference of the Fourth Editorial Board of Chinese Journal of Digestive Surgery, and the Second Elite Group of Chinese Journal of Digestive Surgery, was successfully held in Kunming on July 4, 2025. This conference systematically summarizes the development experience of the journal over the past 20 years from three aspects: the role of ecological construction of thought in the discipline construction of digestive surgery, the display of the latest academic achievements in the field of digestive surgery, the development difficulties, and breakthrough paths of the discipline, and strategically plans the path of discipline construction in the new era.

Patients with pancreatic surgery have a high incidence of preoperative malnutri-tion, large surgical trauma, and many postoperative complications. The practice of enhanced recovery after surgery is difficult. After nearly 20 years of development, the concept of enhanced recovery after surgery (ERAS) has formed mature guidelines and consensus in pancreatic surgery. However, its application is faced with problems such as large central differences, low level of evidence-based, and insufficient completion of rehabilitation processes. The growth of publications in journals on related topics has stagnated, and the research heat has a trend of ebbing. Based on the literature at home and abroad, the authors analyze the bottleneck of application of enhanced recovery after surgery in pancreatic cancer from the aspects of process management, pre-rehabilitation and nutrition management, and look forward to the future research direction.

On the occasion of the 110th Anniversary of the establishment of the Chinese Medical Association, the third conference of the Fourth Editorial Board of Chinese Journal of Digestive Surgery, and the Second Elite Group of Chinese Journal of Digestive Surgery, was successfully held in Kunming on July 4, 2025. This conference systematically summarizes the development experience of the journal over the past 20 years from three aspects: the role of ecological construction of thought in the discipline construction of digestive surgery, the display of the latest academic achievements in the field of digestive surgery, the development difficulties, and breakthrough paths of the discipline, and strategically plans the path of discipline construction in the new era.

Objective:To elucidate the prognostic differences and risk factors associated with different patterns of recurrence and metastasis following pancreatic cancer (PC) resection.Methods:This is a retrospective case series study. Clinicopathological data and follow-up information were retrospectively collected from 210 patients who underwent surgery for PC at the Department of Hepatobiliary and Pancreatic Surgery, Peking University First Hospital, between January 2014 and December 2023. There were 114 males and 96 females; the age was (64.5±10.3) years (range: 29 to 89 years). Survival functions based on different times to recurrence and metastasis and different patterns of recurrence and metastasis were estimated using the Kaplan-Meier method, and survival differences among groups were compared using the Log-rank test. Identifying the optimal cutoff for time to postoperative recurrence/metastasis predicting overall survival (OS) in pancreatic cancer patients via the minimum p-value approach. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors affecting OS following pancreatectomy.Results:A total of 210 patients met the inclusion and exclusion criteria. Among them, 71 patients remained free of recurrence and metastasis, while 139 developed recurrence and metastasis. The patterns included local recurrence ( n=34), liver metastasis ( n=39), lung metastasis ( n=11), peritoneal metastasis ( n=13), multiple sites metastasis ( n=38), bone metastasis ( n=3), and kidney metastasis ( n=1). OS was significantly shorter in the group with postoperative recurrence and metastasis compared to the group without recurrence/metastasis (23.07 months vs.not reached, P<0.01). The optimal cut-off time distinguishing early from late recurrence and metastasis was 13 months. There was a significant difference in post-recurrence survival between patients with early and late recurrence and metastasis (16.03 months vs. 52.40 months, P=0.009). The Kaplan-Meier survival curve showed that different postoperative recurrence and metastasis patterns had different impacts on OS, with lung metastasis showing the best prognosis compared to local recurrence, liver metastasis, peritoneal metastasis, and multiple sites metastasis ( P<0.01). Multivariate Cox analysis revealed that Eastern Cooperative Oncology Group (ECOG) score 1, postoperative carcinoembryonic antigen (CEA) ≥15 μg/L, poor tumor differentiation, postoperative local recurrence, liver metastasis, peritoneal metastasis, and multiple sites metastases are independent risk factors for postoperative recurrence and metastasis (all P<0.05). Conclusions:Considerable prognostic heterogeneity exists in postoperative PC patients depending on the site and pattern of recurrence or metastasis. Specifically, lung metastasis portends a significantly more favorable prognosis than liver metastasis, peritoneal metastasis, local recurrence, or multiple sites metastases. ECOG score 1, postoperative CEA≥15 μg/L, poor tumor differentiation, postoperative local recurrence, liver metastasis, peritoneal metastasis, and multiple sites metastases are independent risk factors for OS in postoperative PC patients.

Pancreatic cancer is a severe malignant tumor that poses a significant threat to human health worldwide, with its incidence and mortality rates increasing annually, especially in economically developed regions. The progress of surgical treatment is of great significance in improving the prognosis of pancreatic cancer patients. This article reviews the recent progress in surgical treatment strategies for pancreatic cancer, with a particular emphasis on the multidisciplinary team (MDT) approach, neoadjuvant therapy, conversion therapy, and the assessment of the effectiveness of neoadjuvant/conversion therapy. The MDT approach, by integrating the strengths of multiple disciplines, provides personalized treatment plans for patients, improving the resection rate and survival rate of patients with pancreatic cancer. Neoadjuvant and conversion therapy provide surgical opportunities for patients with advanced pancreatic cancer, improving their prognosis. Additionally, accurate assessment of treatment effects is crucial for determining the timing and method of surgery.

Objective:To construct a patient-derived organoid model and clarify its predictive value for the sensitivity of pancreatic cancer chemotherapy drugs.Methods:A total of 42 tissue samples from patients with pancreatic ductal adenocarcinoma who underwent surgery or percutaneous biopsy at Peking University First Hospital from 2020 to 2023 were collected. Pancreatic cancer organoid models were constructed through in vitro culture. These organoid models were treated with five most commonly used pancreatic cancer chemotherapy drugs, namely Gemcitabine, nab-Paclitaxel, 5-Fluorouracil, Oxaliplatin, and Irinotecan, to determine the IC 50. The consistency between the organoid drug sensitivity test results and the patients' chemotherapy sensitivity was determined. Results:Patient-derived pancreatic cancer organoid models achieved an establishment success rate of 73.33%. The organoid model could reproduce the pathological features of the patients' tumor tissues; there were individual differences in the sensitivity to the same chemotherapy drug among organoid models derived from different patients. The sensitivity of patient derived organoids was highly consistent with the actual treatment effect of the corresponding patients was 81%.Conclusion:The drug susceptibility test results were significantly correlated with the actual medication response of patients, suggesting that the drug susceptibility test technology based on patient derived organoids has the potential to guide individualized chemotherapy for pancreatic cancer.

Pancreatic cancer is a severe malignant tumor that poses a significant threat to human health worldwide, with its incidence and mortality rates increasing annually, especially in economically developed regions. The progress of surgical treatment is of great significance in improving the prognosis of pancreatic cancer patients. This article reviews the recent progress in surgical treatment strategies for pancreatic cancer, with a particular emphasis on the multidisciplinary team (MDT) approach, neoadjuvant therapy, conversion therapy, and the assessment of the effectiveness of neoadjuvant/conversion therapy. The MDT approach, by integrating the strengths of multiple disciplines, provides personalized treatment plans for patients, improving the resection rate and survival rate of patients with pancreatic cancer. Neoadjuvant and conversion therapy provide surgical opportunities for patients with advanced pancreatic cancer, improving their prognosis. Additionally, accurate assessment of treatment effects is crucial for determining the timing and method of surgery.

Objective:To construct a patient-derived organoid model and clarify its predictive value for the sensitivity of pancreatic cancer chemotherapy drugs.Methods:A total of 42 tissue samples from patients with pancreatic ductal adenocarcinoma who underwent surgery or percutaneous biopsy at Peking University First Hospital from 2020 to 2023 were collected. Pancreatic cancer organoid models were constructed through in vitro culture. These organoid models were treated with five most commonly used pancreatic cancer chemotherapy drugs, namely Gemcitabine, nab-Paclitaxel, 5-Fluorouracil, Oxaliplatin, and Irinotecan, to determine the IC 50. The consistency between the organoid drug sensitivity test results and the patients' chemotherapy sensitivity was determined. Results:Patient-derived pancreatic cancer organoid models achieved an establishment success rate of 73.33%. The organoid model could reproduce the pathological features of the patients' tumor tissues; there were individual differences in the sensitivity to the same chemotherapy drug among organoid models derived from different patients. The sensitivity of patient derived organoids was highly consistent with the actual treatment effect of the corresponding patients was 81%.Conclusion:The drug susceptibility test results were significantly correlated with the actual medication response of patients, suggesting that the drug susceptibility test technology based on patient derived organoids has the potential to guide individualized chemotherapy for pancreatic cancer.

Objective:To elucidate the prognostic differences and risk factors associated with different patterns of recurrence and metastasis following pancreatic cancer (PC) resection.Methods:This is a retrospective case series study. Clinicopathological data and follow-up information were retrospectively collected from 210 patients who underwent surgery for PC at the Department of Hepatobiliary and Pancreatic Surgery, Peking University First Hospital, between January 2014 and December 2023. There were 114 males and 96 females; the age was (64.5±10.3) years (range: 29 to 89 years). Survival functions based on different times to recurrence and metastasis and different patterns of recurrence and metastasis were estimated using the Kaplan-Meier method, and survival differences among groups were compared using the Log-rank test. Identifying the optimal cutoff for time to postoperative recurrence/metastasis predicting overall survival (OS) in pancreatic cancer patients via the minimum p-value approach. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors affecting OS following pancreatectomy.Results:A total of 210 patients met the inclusion and exclusion criteria. Among them, 71 patients remained free of recurrence and metastasis, while 139 developed recurrence and metastasis. The patterns included local recurrence ( n=34), liver metastasis ( n=39), lung metastasis ( n=11), peritoneal metastasis ( n=13), multiple sites metastasis ( n=38), bone metastasis ( n=3), and kidney metastasis ( n=1). OS was significantly shorter in the group with postoperative recurrence and metastasis compared to the group without recurrence/metastasis (23.07 months vs.not reached, P<0.01). The optimal cut-off time distinguishing early from late recurrence and metastasis was 13 months. There was a significant difference in post-recurrence survival between patients with early and late recurrence and metastasis (16.03 months vs. 52.40 months, P=0.009). The Kaplan-Meier survival curve showed that different postoperative recurrence and metastasis patterns had different impacts on OS, with lung metastasis showing the best prognosis compared to local recurrence, liver metastasis, peritoneal metastasis, and multiple sites metastasis ( P<0.01). Multivariate Cox analysis revealed that Eastern Cooperative Oncology Group (ECOG) score 1, postoperative carcinoembryonic antigen (CEA) ≥15 μg/L, poor tumor differentiation, postoperative local recurrence, liver metastasis, peritoneal metastasis, and multiple sites metastases are independent risk factors for postoperative recurrence and metastasis (all P<0.05). Conclusions:Considerable prognostic heterogeneity exists in postoperative PC patients depending on the site and pattern of recurrence or metastasis. Specifically, lung metastasis portends a significantly more favorable prognosis than liver metastasis, peritoneal metastasis, local recurrence, or multiple sites metastases. ECOG score 1, postoperative CEA≥15 μg/L, poor tumor differentiation, postoperative local recurrence, liver metastasis, peritoneal metastasis, and multiple sites metastases are independent risk factors for OS in postoperative PC patients.