The robotic liver resection(RLR)has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system,however,controversies still exist.Base...The robotic liver resection(RLR)has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system,however,controversies still exist.Based on the foundation of the previous consensus statement,this new consensus document aimed to update clinical recommendations and provide guidance to improve the outcomes of RLR clinical practice.The guideline steering group and guideline expert group were formed by 29 international experts of liver surgery and evidence-based medicine(EBM).Relevant literature was reviewed and analyzed by the evidence evaluation group.According to the WHO Handbook for Guideline Development,the Guidance Principles of Development and Amendment of the Guidelines for Clinical Diagnosis and Treatment in China 2022,a total of 14 recommendations were generated.Among them were 8 recommendations formulated by the GRADE method,and the remaining 6 recommendations were formulated based on literature review and experts’opinion due to insufficient EBM results.This international experts consensus guideline offered guidance for the safe and effective clinical practice and the research direction of RLR in future.展开更多
Von Meyenburg complexes are benign liver lesions consisting of adenomatous bile duct proliferates. We present two patients suffering from esophageal cancer accompanied by the occurrence of yon Meyenburg complexes. Pre...Von Meyenburg complexes are benign liver lesions consisting of adenomatous bile duct proliferates. We present two patients suffering from esophageal cancer accompanied by the occurrence of yon Meyenburg complexes. Preoperative computerized tomography （CT） of the liver had not shown these lesions. In one of the patients, diffuse nodular manifestation was found in both liver lobes, mimicking diffuse hepatic metastases. Intraoperative frozen section revealed the benign nature of the lesions in both cases. The patients underwent esophageal resection without complications. To the best of our knowledge, the coincidence of von Meyenburg complexes and esophageal cancer has never been reported before. This uncommon entity should be taken into consideration as a differential diagnosis of liver lesions in malignancies. It underlines the importance of intraoperative frozen section for liver lesions of unknown origin.展开更多
Pancreatic ductal adenocarcinoma(PDAC) remains still one of the most lethal tumor entities and will be the second leading cause of cancer-related death within the next ten years for both male and female patients. This...Pancreatic ductal adenocarcinoma(PDAC) remains still one of the most lethal tumor entities and will be the second leading cause of cancer-related death within the next ten years for both male and female patients. This frustrating development is mainly explained by an increasing incidence and still limited therapeutical success [ 1, 2 ].展开更多
Background:With the rapid development of robotic surgery,especially for the abdominal surgery,robotic pancreatic surgery(RPS)has been applied increasingly around the world.However,evidence-based guidelines regarding i...Background:With the rapid development of robotic surgery,especially for the abdominal surgery,robotic pancreatic surgery(RPS)has been applied increasingly around the world.However,evidence-based guidelines regarding its application,safety,and efficacy are still lacking.To harvest robust evidence and comprehensive clinical practice,this study aims to develop international guidelines on the use of RPS.Methods:World Health Organization(WHO)Handbook for Guideline Development,GRADE Grid method,Delphi vote,and the AGREE-II instrument were used to establish the Guideline Steering Group,Guideline Development Group,and Guideline Secretary Group,formulate 19 clinical questions,develop the recommendations,and draft the guidelines.Three online meetings were held on 04/12/2020,30/11/2021,and 25/01/2022 to vote on the recommendations and get advice and suggestions from all involved experts.All the experts focusing on minimally invasive surgery from America,Europe and Oceania made great contributions to this consensus guideline.Results:After a systematic literature review 176 studies were included,19 questions were addressed and 14 recommendations were developed through the expert assessment and comprehensive judgment of the quality and credibility of the evidence.Conclusions:The international RPS guidelines can guide current practice for surgeons,patients,medical societies,hospital administrators,and related social communities.Further randomized trials are required to determine the added value of RPS as compared to open and laparoscopic surgery.展开更多
The robotic surgical system has been applied to various types of pancreatic surgery. However, controversies exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of r...The robotic surgical system has been applied to various types of pancreatic surgery. However, controversies exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of robotic surgery. This study aimed to evaluate the current status of robotic pancreatic surgery and put forth experts' consensus and recommendations to promote its development. Based on the WHO Handbook for Guideline Development, a Consensus Steering Group* and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 19 topics were analyzed. The first 16 recommendations were generated by GRADE using an evidence-based method (EBM) and focused on the safety, feasibility, indication, techniques, certification of the robotic surgeon, and cost-effectiveness of robotic pancreatic surgery. The remaining three recommendations were based on literature review and expert panel opinion due to insufficient EBM results. Since the current amount of;evidence was low/meager as evaluated by the GRADE method, further randomized controlled trials (RCTs) are needed in the future to validate these recommendations.展开更多
Surgery plays a central role in the treatment of benign and malignant pancreatic diseases.Artificial intelligence(AI)is an important upcoming technology to support surgeons in pre-,intra-,and postoperative diagnosis,d...Surgery plays a central role in the treatment of benign and malignant pancreatic diseases.Artificial intelligence(AI)is an important upcoming technology to support surgeons in pre-,intra-,and postoperative diagnosis,decision-making and training toward an optimized patient care.Current AI applications show a promising role in the evaluation of preoperative images for prediction of malignancy and resectability,intraoperative decision support,surgical training as well as a postoperative risk stratification to per-sonalize the management of complications.This scoping review summarizes the most up to date developments of AI in pancreatic surgery with the highest available level of evidence.展开更多
This retrospective single centre report of 36 patients with resectable pancreatic cancer who had neoadjuvant systemic chemotherapy,found that only 25(69%)of patients could undergo resection with a median overall survi...This retrospective single centre report of 36 patients with resectable pancreatic cancer who had neoadjuvant systemic chemotherapy,found that only 25(69%)of patients could undergo resection with a median overall survival of 34.4 months(1).They concluded that a short course of neoadjuvant chemotherapy without chemoradiation may improve patient selection prior to surgical resection(1).Whilst the notion that effective neoadjuvant therapy does not require chemoradiation is interesting this study demonstrates the weaknesses of retrospective studies.Progress in the treatment of pancreatic cancer has only taken place through well designed prospective randomized controlled trials.展开更多
In response to“What’s the next step in evaluating laparoscopic pancreaticoduodenectomy?”(http://hbsn.amegroups.com/article/view/29682/25710)by Fernando Burdío,Luís Grand and Ignasi Poves.First and foremos...In response to“What’s the next step in evaluating laparoscopic pancreaticoduodenectomy?”(http://hbsn.amegroups.com/article/view/29682/25710)by Fernando Burdío,Luís Grand and Ignasi Poves.First and foremost,we would like to express our sincere condolences on the passing of Professor Ignasi Poves.We were deeply saddened to hear of this and wish his family,friends and colleagues strength in these difficult times of grieving.展开更多
In a recently published Nature article,Lee et al.investigated distinct metabolic dependencies of pancreatic ductal adenocarcinoma(PDA)cells compared to normal tissue,and discovered that PDA cells exhibited a unique re...In a recently published Nature article,Lee et al.investigated distinct metabolic dependencies of pancreatic ductal adenocarcinoma(PDA)cells compared to normal tissue,and discovered that PDA cells exhibited a unique reliance on de novo ornithine synthesis from glutamine,rather than arginine.This aberrant polyamine synthesis offers a promising therapeutic target for pancreatic cancer.展开更多
The natural connection between the duodenum and the pancreatic duct enables a minimally invasive access to the pancreas.Endoscopically this access is already regularly used,mainly for diagnostic and even for certain t...The natural connection between the duodenum and the pancreatic duct enables a minimally invasive access to the pancreas.Endoscopically this access is already regularly used,mainly for diagnostic and even for certain therapeutic purposes.With per-oral pancreatoscopy the endopancreatic approach allows the direct visualization of the pancreatic duct system potentially improving the diagnostic work-up of pancreatic cystic neoplasms,intrapancreatic strictures and removal of pancreatic duct stones.However,the endopancreatic access can equally be applied for surgical interventions.The objective of this review is to summarize endoscopic and surgical interventions using the endopancreatic access.Endopancreatic surgery stands for a further development of the endoscopic technique:a rigid endoscope is transabdominally introduced over the duodenum and the papilla to enable resections of strictures and inflamed tissue from inside the pancreas under visual control.While the orientation and localization of target structures using this minimally invasive approach is difficult,the development of an accurate image guidance system will play a key role for the clinical implementation and widespread use of endoscopic and surgical endopancreatic interventions.展开更多
First,we would like to congratulate Liu et al.for their successful multicenter study including 1,032 patients undergoing robotic pancreaticoduodenectomy(RPD)and 1,154 open pancreaticoduodenectomy(OPD)in seven high vol...First,we would like to congratulate Liu et al.for their successful multicenter study including 1,032 patients undergoing robotic pancreaticoduodenectomy(RPD)and 1,154 open pancreaticoduodenectomy(OPD)in seven high volume centers in China over an 8 year period(1).To ensure the best possible outcomes of both techniques,RPD was performed by five surgeons from three centers after overcoming the individual learning curve that was defined as having performed>40 RPD.On the other hand,OPD was performed by 9 surgeons from 6 centers after reaching the individual learning curve,defined as an experience of>60 OPD.展开更多
Interdisciplinary perioperative treatment has greatly improved the outcome of pancreatic cancer patients.Based on randomized,controlled phase III clinical trials,adjuvant chemotherapy with mFOLFIRINOX(PRODIGE-24 study...Interdisciplinary perioperative treatment has greatly improved the outcome of pancreatic cancer patients.Based on randomized,controlled phase III clinical trials,adjuvant chemotherapy with mFOLFIRINOX(PRODIGE-24 study),gemcitabine/capecitabine(ESPAC-4)or 5-fluorouracil/gemcitabine monotherapy(ESPAC-1,CONKO-001,ESPAC-3)is now the clinical standard after curative resection(1).展开更多
文摘The robotic liver resection(RLR)has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system,however,controversies still exist.Based on the foundation of the previous consensus statement,this new consensus document aimed to update clinical recommendations and provide guidance to improve the outcomes of RLR clinical practice.The guideline steering group and guideline expert group were formed by 29 international experts of liver surgery and evidence-based medicine(EBM).Relevant literature was reviewed and analyzed by the evidence evaluation group.According to the WHO Handbook for Guideline Development,the Guidance Principles of Development and Amendment of the Guidelines for Clinical Diagnosis and Treatment in China 2022,a total of 14 recommendations were generated.Among them were 8 recommendations formulated by the GRADE method,and the remaining 6 recommendations were formulated based on literature review and experts’opinion due to insufficient EBM results.This international experts consensus guideline offered guidance for the safe and effective clinical practice and the research direction of RLR in future.
文摘Von Meyenburg complexes are benign liver lesions consisting of adenomatous bile duct proliferates. We present two patients suffering from esophageal cancer accompanied by the occurrence of yon Meyenburg complexes. Preoperative computerized tomography （CT） of the liver had not shown these lesions. In one of the patients, diffuse nodular manifestation was found in both liver lobes, mimicking diffuse hepatic metastases. Intraoperative frozen section revealed the benign nature of the lesions in both cases. The patients underwent esophageal resection without complications. To the best of our knowledge, the coincidence of von Meyenburg complexes and esophageal cancer has never been reported before. This uncommon entity should be taken into consideration as a differential diagnosis of liver lesions in malignancies. It underlines the importance of intraoperative frozen section for liver lesions of unknown origin.
文摘Pancreatic ductal adenocarcinoma(PDAC) remains still one of the most lethal tumor entities and will be the second leading cause of cancer-related death within the next ten years for both male and female patients. This frustrating development is mainly explained by an increasing incidence and still limited therapeutical success [ 1, 2 ].
文摘Background:With the rapid development of robotic surgery,especially for the abdominal surgery,robotic pancreatic surgery(RPS)has been applied increasingly around the world.However,evidence-based guidelines regarding its application,safety,and efficacy are still lacking.To harvest robust evidence and comprehensive clinical practice,this study aims to develop international guidelines on the use of RPS.Methods:World Health Organization(WHO)Handbook for Guideline Development,GRADE Grid method,Delphi vote,and the AGREE-II instrument were used to establish the Guideline Steering Group,Guideline Development Group,and Guideline Secretary Group,formulate 19 clinical questions,develop the recommendations,and draft the guidelines.Three online meetings were held on 04/12/2020,30/11/2021,and 25/01/2022 to vote on the recommendations and get advice and suggestions from all involved experts.All the experts focusing on minimally invasive surgery from America,Europe and Oceania made great contributions to this consensus guideline.Results:After a systematic literature review 176 studies were included,19 questions were addressed and 14 recommendations were developed through the expert assessment and comprehensive judgment of the quality and credibility of the evidence.Conclusions:The international RPS guidelines can guide current practice for surgeons,patients,medical societies,hospital administrators,and related social communities.Further randomized trials are required to determine the added value of RPS as compared to open and laparoscopic surgery.
基金the National Key Research and Development Program of China(grand number 2017YFC0110405)the National Natural Science Foundation of China(grant number 81500499).
文摘The robotic surgical system has been applied to various types of pancreatic surgery. However, controversies exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of robotic surgery. This study aimed to evaluate the current status of robotic pancreatic surgery and put forth experts' consensus and recommendations to promote its development. Based on the WHO Handbook for Guideline Development, a Consensus Steering Group* and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 19 topics were analyzed. The first 16 recommendations were generated by GRADE using an evidence-based method (EBM) and focused on the safety, feasibility, indication, techniques, certification of the robotic surgeon, and cost-effectiveness of robotic pancreatic surgery. The remaining three recommendations were based on literature review and expert panel opinion due to insufficient EBM results. Since the current amount of;evidence was low/meager as evaluated by the GRADE method, further randomized controlled trials (RCTs) are needed in the future to validate these recommendations.
文摘Surgery plays a central role in the treatment of benign and malignant pancreatic diseases.Artificial intelligence(AI)is an important upcoming technology to support surgeons in pre-,intra-,and postoperative diagnosis,decision-making and training toward an optimized patient care.Current AI applications show a promising role in the evaluation of preoperative images for prediction of malignancy and resectability,intraoperative decision support,surgical training as well as a postoperative risk stratification to per-sonalize the management of complications.This scoping review summarizes the most up to date developments of AI in pancreatic surgery with the highest available level of evidence.
文摘This retrospective single centre report of 36 patients with resectable pancreatic cancer who had neoadjuvant systemic chemotherapy,found that only 25(69%)of patients could undergo resection with a median overall survival of 34.4 months(1).They concluded that a short course of neoadjuvant chemotherapy without chemoradiation may improve patient selection prior to surgical resection(1).Whilst the notion that effective neoadjuvant therapy does not require chemoradiation is interesting this study demonstrates the weaknesses of retrospective studies.Progress in the treatment of pancreatic cancer has only taken place through well designed prospective randomized controlled trials.
基金Support for open access publication was provided by Baden-Württemberg Ministry of Science,Research and the Arts and by Ruprecht-Karls-Universität Heidelberg.
文摘In response to“What’s the next step in evaluating laparoscopic pancreaticoduodenectomy?”(http://hbsn.amegroups.com/article/view/29682/25710)by Fernando Burdío,Luís Grand and Ignasi Poves.First and foremost,we would like to express our sincere condolences on the passing of Professor Ignasi Poves.We were deeply saddened to hear of this and wish his family,friends and colleagues strength in these difficult times of grieving.
文摘In a recently published Nature article,Lee et al.investigated distinct metabolic dependencies of pancreatic ductal adenocarcinoma(PDA)cells compared to normal tissue,and discovered that PDA cells exhibited a unique reliance on de novo ornithine synthesis from glutamine,rather than arginine.This aberrant polyamine synthesis offers a promising therapeutic target for pancreatic cancer.
文摘The natural connection between the duodenum and the pancreatic duct enables a minimally invasive access to the pancreas.Endoscopically this access is already regularly used,mainly for diagnostic and even for certain therapeutic purposes.With per-oral pancreatoscopy the endopancreatic approach allows the direct visualization of the pancreatic duct system potentially improving the diagnostic work-up of pancreatic cystic neoplasms,intrapancreatic strictures and removal of pancreatic duct stones.However,the endopancreatic access can equally be applied for surgical interventions.The objective of this review is to summarize endoscopic and surgical interventions using the endopancreatic access.Endopancreatic surgery stands for a further development of the endoscopic technique:a rigid endoscope is transabdominally introduced over the duodenum and the papilla to enable resections of strictures and inflamed tissue from inside the pancreas under visual control.While the orientation and localization of target structures using this minimally invasive approach is difficult,the development of an accurate image guidance system will play a key role for the clinical implementation and widespread use of endoscopic and surgical endopancreatic interventions.
文摘First,we would like to congratulate Liu et al.for their successful multicenter study including 1,032 patients undergoing robotic pancreaticoduodenectomy(RPD)and 1,154 open pancreaticoduodenectomy(OPD)in seven high volume centers in China over an 8 year period(1).To ensure the best possible outcomes of both techniques,RPD was performed by five surgeons from three centers after overcoming the individual learning curve that was defined as having performed>40 RPD.On the other hand,OPD was performed by 9 surgeons from 6 centers after reaching the individual learning curve,defined as an experience of>60 OPD.
文摘Interdisciplinary perioperative treatment has greatly improved the outcome of pancreatic cancer patients.Based on randomized,controlled phase III clinical trials,adjuvant chemotherapy with mFOLFIRINOX(PRODIGE-24 study),gemcitabine/capecitabine(ESPAC-4)or 5-fluorouracil/gemcitabine monotherapy(ESPAC-1,CONKO-001,ESPAC-3)is now the clinical standard after curative resection(1).
