Basophils,which are considered as redundant relatives of mast cells and the rarest granulocytes in peripheral circulation,have been neglected by researchers in the past decades.Previous studies have revealed their vit...Basophils,which are considered as redundant relatives of mast cells and the rarest granulocytes in peripheral circulation,have been neglected by researchers in the past decades.Previous studies have revealed their vital roles in allergic diseases and parasitic infections.Intriguingly,recent studies even reported that basophils might be associated with cancer development,as activated basophils synthesize and release a variety of cytokines and chemokines in response to cancers.However,it is still subject to debate whether basophils function as tumor-protecting or tumor-promoting components;the answer may depend on the tumor biology and the microenvironment.Herein,we reviewed the role of basophils in cancers,and highlighted some potential and promising therapeutic strategies.展开更多
Objective:Currently,pre-treatment prediction of patients with pancreatic neuroendocrine tumors with liver metastases(PNELM)receiving surufatinib treatment was unsatisfying.Our objective was to examine the association ...Objective:Currently,pre-treatment prediction of patients with pancreatic neuroendocrine tumors with liver metastases(PNELM)receiving surufatinib treatment was unsatisfying.Our objective was to examine the association between radiological characteristics and efficacy/prognosis.Methods:We enrolled patients with liver metastases in the phase III,SANET-p trial(NCT02589821)and obtained contrast-enhanced computed tomography(CECT)images.Qualitative and quantitative parameters including hepatic tumor margins,lesion volumes,enhancement pattern,localization types,and enhancement ratios were evaluated.The progression-free survival(PFS)and hazard ratio(HR)were calculated using Cox’s proportional hazard model.Efficacy was analyzed by logistic-regression models.Results:Among 152 patients who had baseline CECT assessments and were included in this analysis,the surufatinib group showed statistically superior efficacy in terms of median PFS compared to placebo across various qualitative and quantitative parameters.In the multivariable analysis of patients receiving surufatinib(N=100),those with higher arterial phase standardized enhancement ratio-peri-lesion(ASER-peri)exhibited longer PFS[HR=0.039;95%confidence interval(95%CI):0.003−0.483;P=0.012].Furthermore,patients with a high enhancement pattern experienced an improvement in the objective response ratio[31.3%vs.14.7%,odds ratio(OR)=3.488;95%CI:1.024−11.875;P=0.046],and well-defined tumor margins were associated with a higher disease control rate(DCR)(89.3%vs.68.2%,OR=4.535;95%CI:1.285−16.011;P=0.019)compared to poorlydefined margins.Conclusions:These pre-treatment radiological features,namely high ASER-peri,high enhancement pattern,and well-defined tumor margins,have the potential to serve as predictive markers of efficacy in patients with PNELM receiving surufatinib.展开更多
Background and Objective:Obesity is a global health issue closely linked to multiple cardiovascular and metabolic conditions.The renaming of nonalcoholic fatty liver disease(NAFLD)to metabolic dysfunction-associated f...Background and Objective:Obesity is a global health issue closely linked to multiple cardiovascular and metabolic conditions.The renaming of nonalcoholic fatty liver disease(NAFLD)to metabolic dysfunction-associated fatty liver disease(MAFLD)has sparked discussions about renaming nonalcoholic fatty pancreas disease(NAFPD).This narrative review explores the potential benefits and challenges of renaming NAFPD to metabolic dysfunction-associated fatty pancreas disease(MAFPD)and its potential clinical implications.Methods:The review employs a narrative approach,synthesizing existing literature and expert opinions to evaluate the rationale behind and the possible implications of renaming NAFPD to MAFPD.Key Content and Findings:NAFPD is increasingly recognized worldwide but lacks standardized diagnostic criteria,hindering its independent classification as a disease.Renaming NAFPD to MAFPD may enhance diagnostic accuracy,prognostic prediction,and personalized treatment strategies.It may also facilitate global epidemiological research,data sharing,and collaboration.Major challenges include establishing uniform diagnostic guidelines for promoting and educating about the newly proposed terminology.Conclusions:The proposed renaming from NAFPD to MAFPD may offer promising benefits despite challenges.It may also lead to improved management and understanding of the disease,potentially benefiting global healthcare strategies aimed at addressing obesity-related pancreatic complications.展开更多
Objectives:We assess the incidence of exocrine pancreatic insufficiency(EPI)at different time points after pancreatic surgery and explore pancreatic enzyme replacement therapy’s(PERT)efficacy.Background:EPI is charac...Objectives:We assess the incidence of exocrine pancreatic insufficiency(EPI)at different time points after pancreatic surgery and explore pancreatic enzyme replacement therapy’s(PERT)efficacy.Background:EPI is characterized by inadequate pancreatic enzymes,resulting in maldigestion and abdominal symptoms.EPI is a common postoperative complication of pancreatic surgery,yet often overlooked by surgeons.There is no clear answer to when EPI occurs after pancreatic surgery nor the duration of PERT after partial pancreatectomy.Methods:Benign or borderline pancreatic tumor patients undergoing surgeries were recruited between December 2020 and November 2021 from 10 medical centers in China.The EPI Questionnaire(EPI-Q)was performed at discharge,and 3-,6-,9-,and 12-month follow-ups to evaluate the occurrence of EPI.Statistical analyses were performed to identify the occurrence of EPI and explore PERT’s efficacy.Results:Of the 146 patients,105(71.9%)were female,and the median age was 49(range 16–78 years).Symptoms of EPI patients were most pronounced within 3 months post-surgery(15.7%),while most patients recovered after 1 year(96.9%).There was a negative correlation between symptom score and time since surgery.Lack of PERT in the 3-month post-surgery was associated with higher symptom scores in pancreatoduodenectomy(PD)patients,while not in distal pancreatectomy(DP)patients.Conclusions:Generally,the high-occurrence period for postoperative EPI is within 3 months after resection in patients with benign or borderline pancreatic tumors,and most will gradually recuperate with time.PERT can improve symptoms in PD patients,while reduced PERT duration may be considered for DP patients.展开更多
Background and Objective:Cachexia-induced skeletal muscle atrophy is a critical manifestation in Kirsten rat sarcoma viral oncogene homologue(KRAS)-mutant pancreatic cancer(PC)patients,predominantly characterized by a...Background and Objective:Cachexia-induced skeletal muscle atrophy is a critical manifestation in Kirsten rat sarcoma viral oncogene homologue(KRAS)-mutant pancreatic cancer(PC)patients,predominantly characterized by a shift in metabolic equilibrium towards catabolism that accelerates protein degradation in myofibers and leads to muscle atrophy.This metabolic reprogramming not only supports tumor growth but also precipitates energy depletion in skeletal muscle tissues.Exploring these mechanisms reveals potential therapeutic targets in the metabolic and proteolytic pathways associated with KRAS-mutant PC.Methods:A comprehensive search for literature was conducted in PubMed,Web of Science,Google Scholar and other search engines up to May 21st,2024.Studies on PC models and patients were included.Key Content and Findings:The crosstalk between KRAS-mutant PC and skeletal muscle atrophy can be categorized into four principal domains:(I)KRAS-driven metabolic reprogramming in cancer cells leads to the depletion of muscle energy reserves,thereby influencing the reallocation of myofiber energy towards fueling cancer cell;(Ⅱ)KRAS-mutant cancer cells rely on nutrient-scavenging pathways,resulting in altered cytokine profiles,increased ubiquitin mRNA expression and autophagy-lysosome pathway,which facilitate myotube degradation and inhibit muscle regeneration,thereby disrupting muscular homeostasis and causing a one-way nutrient flux;(Ⅲ)tumor-induced oxidative stress inflicts damage on myotubes,highlighting the detrimental effects of reactive oxygen species on muscle structure;(Ⅳ)KRAS-mutant cancer cells remodulate immune cell dynamics within the tumor environment,thereby reshaping host immunity.Together,these findings illuminate the intricate interplay between KRAS-mutant PC and skeletal muscle atrophy,mapping the pathophysiological framework that is crucial for understanding sarcopenia and related disorders.Conclusions:This comprehensive analysis advances our understanding of the complex etiology of cancer cachexia and stimulates the development of targeted therapeutic strategies.展开更多
Background:A growing body of evidence supports the use of laparoscopic pancreaticoduodenectomy(LPD)as an efficient and feasible surgical technique.However,few studies have investigated its applicability in pancreatic ...Background:A growing body of evidence supports the use of laparoscopic pancreaticoduodenectomy(LPD)as an efficient and feasible surgical technique.However,few studies have investigated its applicability in pancreatic ductal adenocarcinoma(PDAC),and the long-term efficacy of LPD on PDAC remains unclear.This study aimed to compare the short-and long-term outcomes between LPD and open pancreaticoduodenectomy(OPD)for PDAC.Methods:The data of patients who had OPD or LPD for PDAC between January 2013 and September 2017 were retrieved.Their postoperative outcomes and survival were compared after propensity score matching.Results:A total of 309 patients were included.After a 2:1 matching,93 cases in the OPD group and 55 in the LPD group were identified.Delayed gastric emptying(DGE),particularly grade B/C DGE,occurred less frequently in the LPD group than in the OPD group(1.8%vs.36.6%,P<0.001;1.8%vs.22.6%,P=0.001).The overall complication rates were significantly lower in the LPD group than in the OPD group(49.1%vs.71.0%,P=0.008),whereas the rates of major complications were similar(10.9%vs.14.0%,P=0.590).In addition,the median overall survival was comparable between the two groups(20.0 vs.18.7 months,P=0.293).Conclusion:LPD was found to be technically feasible with efficacy similar to OPD for patients with PDAC.展开更多
Objective: In 2015, the Chinese Pancreatic Association of the Chinese Society of Surgery of the Chinese Medical Association launched a national multicenter online system for registration of surgical treatment of pancr...Objective: In 2015, the Chinese Pancreatic Association of the Chinese Society of Surgery of the Chinese Medical Association launched a national multicenter online system for registration of surgical treatment of pancreatic cancer in China, called China Pancreas Data Center (CPDC). With continued effort, the CPDC has developed over time. Herein, we report the general results of the CPDC from January 2016 to January 2020 to present the real-world situation of surgical treatment of pancreatic cancer in China.Methods: The data of the CPDC from January 2016 to January 2020 were retrieved and analyzed in this real-world study, including the data on patient demographics, comorbidities, diagnostic modalities, neoadjuvant treatment, surgical procedures, postoperative complications and treatment, pathological examinations, postoperative adjuvant treatment, survival, and risk factors.Results: A total of 13,595 cases from 70 centers in 28 provinces were retrieved for analysis. This study reported the largest cohort of patients who underwent surgical treatment for pancreatic cancer in China to date. More cases were derived from the Eastern regions, among which Shanghai, Beijing, and Zhejiang ranked in the top three. The peak age of the patients ranged from 60 to 69 years. The ratio of males to females was 1.5:1. Overall, 64.3% of the tumors were located in the head and neck of the pancreas, and 35.7% in the body and tail of the pancreas. Of the patients, 23.0% underwent positron-emission tomography-computed tomography, 21.6% underwent endoscopic ultrasound, and 4.8% underwent preoperative biopsy. Two percent of the patients underwent neoadjuvant treatment, while 68.9% underwent R0 surgical resection (margin free of tumor cells). Of the latter, 78.6% of the operations were open procedures, 12.6% were laparoscopic procedures, 2.9% were robotic procedures, and 3.7% were converted to open procedures. The in-hospital mortality rate after surgery was 0.4%. The incidence of grade 2 and grade 3 postoperative pancreatic fistulas was 25.5% and 2.5%, respectively. The incidence of complications based on the Clavien-Dindo classification was 17.9% of grade II, 4.3% of grade IIIa, 1% of grade IIIb, and 0.6% of grade IV. Of the patients, 28.9% underwent postoperative adjuvant chemotherapy. The 1-year, 2-year, and 3-year overall survival of these patients were 77%, 51%, and 38%, respectively. In the 8542 patients who underwent R0 resection, the 1-year, 2-year, and 3-year overall survival and disease-free survival were 77% , 54%, and 43%, and 68%, 49%, and 41%, respectively. The factors related to the prognosis of these patients were also identified after uni-and multi-variate analyses.Conclusion: The surgical quality, safety, and long-term survival of the patients in CPDC are similar to those of international high-volume pancreatic centers. However, neoadjuvant and postoperative adjuvant chemotherapy should be improved.展开更多
Many management strategies are available for pancreatic neuroendocrine neoplasms with liver metastases.However,a lack of biological,molecular,and genomic information and an absence of data from rigorous trials limit t...Many management strategies are available for pancreatic neuroendocrine neoplasms with liver metastases.However,a lack of biological,molecular,and genomic information and an absence of data from rigorous trials limit the validity of these strategies.This review presents the viewpoints from an international conference consisting of several expert working groups.The working groups reviewed a series of questions of particular interest to clinicians taking care of patients with pancreatic neuroendocrine neoplasms with liver metastases by reviewing the existing management strategies and literature,evaluating the evidence on which management decisions were based,developing internationally acceptable recommendations for clinical practice,and making recommendations for clinical and research endeavors.The review for each question will be followed by recommendations from the panel.展开更多
Acute pancreatitis(AP)is a common acute abdominal condition of the digestive system.In recent years,treatment concepts,methods,and strategies for the diagnosis of AP have advanced,and this has played an important role...Acute pancreatitis(AP)is a common acute abdominal condition of the digestive system.In recent years,treatment concepts,methods,and strategies for the diagnosis of AP have advanced,and this has played an important role in promoting the standardization of AP diagnosis and treatment and improving the treatment quality of AP patients.On the basis of previous guidelines and expert consensus,this guideline adopts an evidence-based,problem-based expression;synthesizes important clinical research data at home and abroad in the most recent 5 years;and forms 29 recommendations through multidisciplinary expert discussion,including diagnosis,treatment,and follow-up.It is expected to provide evidence support for the treatment of AP in the clinical setting in China.展开更多
The World Health Organization(WHO)2017 classifications for neuroendocrine neoplasms(NENs)subdivided grade 3 pancreatic neuroendocrine neoplasms(pNENs)into G3 well-differentiated pancreatic neuroendocrine tumors(G3 pNE...The World Health Organization(WHO)2017 classifications for neuroendocrine neoplasms(NENs)subdivided grade 3 pancreatic neuroendocrine neoplasms(pNENs)into G3 well-differentiated pancreatic neuroendocrine tumors(G3 pNETs)and poorly differentiated pancreatic neuroendocrine carcinomas(pNECs),according to the mitotic count,Ki-67 index,and cell differentiation.As a new category,G3 pNETs remain a challenging group of tumors to manage by lacking large randomized trials and consensus to support its clinical practice.Therefore,the Chinese Pancreatic Surgery Association,Chinese Society of Surgery,Chinese Medical Association gathered experts in this field to formulate this consensus for the diagnosis and treatment of G3 pNETs.展开更多
Objective: It remains unclear whether adjuvant chemoradiotherapy (CRT) improves survival outcome of pancreatic ductal adenocarcinoma (PDAC) patients after surgery. This study aimed to investigate the efficacy and safe...Objective: It remains unclear whether adjuvant chemoradiotherapy (CRT) improves survival outcome of pancreatic ductal adenocarcinoma (PDAC) patients after surgery. This study aimed to investigate the efficacy and safety of tegafur/gimeracil/oteracil (S-1)-based adjuvant concurrent chemoradiotherapy in resected PDAC patients with defined high-risk pathological features.Methods: We conducted a single-arm, prospective, and interventional study at Zhongshan Hospital Fudan University from December 2012 to December 2019 and the last follow-up was conducted in December 2021. This study was approved by the Ethics Committee of Zhongshan Hospital Fudan University on December 27, 2012 (approval No. B2012-139). Resected PDAC patients with high-risk pathological features, including positive resection margin, pathological T3-4N1-2M0 disease, peripancreatic fat invasion, microvascular invasion, and perineural invasion, were recruited. Primary endpoint was overall survival and secondary endpoints were disease-free survival, treatment toxicity, and 2-, 5-year survival rates.Results: A total of 54 patients were recruited. Mean age was 63.6 years old (±7.2). The distribution of T and N stages were 24.1% for T1, 46.3% for T2, 27.8% for T3, 1.9% for T4, 33.3% for N1, and 11.1% for N2. Seven patients had R1 resection. The median overall survival and disease-free survival were 27.1 and 13.7 months, respectively, while no fatal adverse events were recorded. Subgroup analyses showed differences in survival outcomes among patients with microvascular invasion, different N stages, and preoperative CA 19-9 levels. Further, a Cox proportional hazard model demonstrated associations of lymph node metastases, CA 19-9 level, and microvascular invasion with overall survival and disease-free survival.Conclusion: S-1 -based adjuvant CRT showed promising efficacy and manageable toxicity in resected PDAC patients with highrisk pathological features.展开更多
The incidence of pancreatic cancer has been rising worldwide,and its clinical diagnosis and treatment remain a great challenge.To present the update and improvements in the clinical diagnosis and treatment of pancreat...The incidence of pancreatic cancer has been rising worldwide,and its clinical diagnosis and treatment remain a great challenge.To present the update and improvements in the clinical diagnosis and treatment of pancreatic cancer in recent years,Chinese Pancreatic Association,the Chinese Society of Surgery,Chinese Medical Association revised the Guidelines for the Diagnosis and Treatment of Pancreatic Cancer in China(2014)after reviewing evidence-based and problem-oriented literature published during 2015-2021,mainly focusing on highlight issues regarding diagnosis and surgical treatment of pancreatic cancer,conversion strategies for locally advanced pancreatic cancer,treatment of pancreatic cancer with oligo metastasis,adjuvant and neoadjuvant therapy,standardized processing of surgical specimens and evaluation of surgical margin status,systemic treatment for unresectable pancreatic cancer,genetic testing,as well as postoperative follow up of patients with pancreatic cancer.Forty recommendation items were finally proposed based on the above issues,and the quality of evidence and strength of recommendations were graded using the Grades of Recommendation,Assessment,Development,and Evaluation system.This guideline aims to standardize the clinical diagnosis and therapy,especially surgical treatment of pancreatic cancer in China,and further improve the prognosis of patients with pancreatic cancer.展开更多
Objective:The aim of this study is to investigate the current status of the diagnosis and treatment of patients with pancreatic neuroendocrine neoplasms(pNENs)undergoing surgery in China.Methods:This is a multicenter ...Objective:The aim of this study is to investigate the current status of the diagnosis and treatment of patients with pancreatic neuroendocrine neoplasms(pNENs)undergoing surgery in China.Methods:This is a multicenter cross-sectional study performed in China.Data from patients with pNENs undergoing surgery at 33 high-volume medical centers,where the number of pancreatectomies exceeds 20 cases per year,were collected and analyzed between March 1,2016 and February 28,2017.Results:In total,392 patients with pNENs were enrolled.The male to female ratio was 1.4.The majority of patients were aged between 40 and 70 years.65.6%of the patients had non-functional tumors.Among those with functional tumors,the percentages of insulinomas,gastrinomas,glucagonomas,and vasoactive intestinal peptide-secreting tumors were 94.8%,1.5%,2.2%,and 1.5%,respectively.Multidisciplinary team(MDT)discussion was conducted for 39.0%of the patients.Minimally invasive surgery was performed on 31.1%of the 392 patients.The incidence of grade B/C pancreatic fistula formation was 4.4%.A total of 89.0%of the surgeries achieved R0 resection,and 41.6%of the tumors were well differentiated.Lymph node metastasis was present in 8.9%of the patients.The percentages of patients with grades G1,G2,and G3 disease were 49.2%,45.7%,and 5.1%,respectively.Conclusion:This multicenter cross-sectional study systematically presents the current status of the diagnosis and treatment of patients with pNENs undergoing surgery in China.MDT consultation for pNENs has not been widely implemented in China.Although the incidence of surgical complications is relatively low,minimally invasive procedures should be further promoted.This study shows us how to improve the outcomes of these patients.展开更多
Pancreatic neuroendocrine tumors(pNETs)might present as part of a complex of hereditary(familial)syndromes caused by germline mutations such as multiple endocrine neoplasia type 1(MEN1),von Hippel-Lindau syndrome(VHL)...Pancreatic neuroendocrine tumors(pNETs)might present as part of a complex of hereditary(familial)syndromes caused by germline mutations such as multiple endocrine neoplasia type 1(MEN1),von Hippel-Lindau syndrome(VHL),tuberous sclerosis,and neurofibromatosis syndromes.Hereditary pNETs are frequently misdiagnosed because their presentation may mimic other more common diseases,resulting in diagnostic delays.Although non-operative(conservative)management could be advocated in select cases in most patients,hereby avoiding surgery without loss of oncological safety,some cases still need operative intervention before malignancy develops.The objective of this review is to address the most recent literature and the evidence it provides for the indications,timing and options of operative treatment for concomitant pNETs in hereditary tumor syndromes.Complete sequencing of the whole gene is recommended for suspected hereditary pNETs.Proven functional pNETs with hereditary tumor syndromes is a good indication for surgical treatment.Conservative management for MEN1 patients with a non-functional pNET of 2cm or smaller is associated with a low risk of malignant transformation and metastasis development.VHL-related pNETs patients with tumor size>1.5cm or a missense mutation or any mutation type in exon 3 may benefit from surgical intervention.The parenchyma-sparing surgical strategy should be preferentially performed whenever possible in all hereditary syndromes.The decision to recommend surgery to prevent malignant transformation and tumor spread,which is based on multidisciplinary expertise and the patient’s preference,should be balanced with operative mortality and morbidity.展开更多
Objective: The aim of this study is to investigate the current status of pancreatic cancer patients undoing surgical treatment in China and to find ways to improve the survival of these patients in the future. Methods...Objective: The aim of this study is to investigate the current status of pancreatic cancer patients undoing surgical treatment in China and to find ways to improve the survival of these patients in the future. Methods: This study is a national, multicenter, cross-sectional study in China. Information regarding pancreatic cancer patients undergoing surgical treatment from 34 high-volume tertiary IIIA level hospitals was collected and analyzed from the March 1, 2016 to the February 28, 2017. Results: In total, 2200 pancreatic cancer patients were enrolled from 34 tertiary IIIA level hospitals in 16 provinces across China. The male-to-female ratio was 1.5. More than 80% of the patients were between 50 and 70 years old. The top 4 symptoms were epigastric discomfort, abdominal pain, jaundice, and weight loss. Carbohydrate antigen 19-9 and carcinoembryonic antigen were elevated in 70.9% and 27.1% of patients, respectively. A multidisciplinary team (MDT) discussion was carried out for 35.0% of patients before surgery. The proportion of minimally invasive pancreatic surgeries was approximately 20%. A total of 83.4% of the operations achieved R0 resection, and the incidence of grade 3/4 postoperative complications was 7.7%. Only 13.4% of the patients received postoperative adjuvant chemotherapy. The percentage of pathological stage I tumors was only 24.5%. Conclusion: The majority of pancreatic cancer patients undergoing surgical resection in China are in an advanced stage. The MDT consultations for pancreatic cancer have not been widely carried out. R0 resection has been achieved in most cases, with relatively low incidence of serious complications, but minimally invasive pancreatic surgery should be further promoted. The application of postoperative chemotherapy remains low. This national, multicentre, cross-sectional study comprehensively presents the current status of pancreatic cancer patients undergoing surgical treatment and shows the road to improve survival of these patients in the future.展开更多
Pancreatic neuroendocrine neoplasms(pNENs)are highly heterogeneous,and the management of pNENs patients can be intractable.To address this challenge,an expert committee was established on behalf of the Chinese Pancrea...Pancreatic neuroendocrine neoplasms(pNENs)are highly heterogeneous,and the management of pNENs patients can be intractable.To address this challenge,an expert committee was established on behalf of the Chinese Pancreatic Surgery Association,which consisted of surgical oncologists,gastroenterologists,medical oncologists,endocrinologists,radiologists,pathologists,and nuclear medicine specialists.By reviewing the important issues regarding the diagnosis and treatment of pNENs,the committee concluded evidence-based statements and recommendations in this article,in order to further improve the management of pNENs patients in China.展开更多
Pancreatic ductal adenocarcinoma is the known kind of tumor biologically featured as high malignant degree, lack of effective methods for diagnosis and treatment, which reflects its unpleasant prognosis. Recently, wit...Pancreatic ductal adenocarcinoma is the known kind of tumor biologically featured as high malignant degree, lack of effective methods for diagnosis and treatment, which reflects its unpleasant prognosis. Recently, with the breakthrough of burgeoning therapeutic methods, the flush of dawn for pancreatic cancer nearly arrives. Nowadays, besides surgery, neoadjuvant chemoradiotherapy, tumor vaccine therapy, and immunotherapy all show their active situation and obtain certain clinical efficacy, but that is still limited to pancreatic cancer. However, the appearance and development of programmed cell death-1 (PD-1) immune checkpoint inhibitor may final improve survival of pancreatic cancer. This article aims to deeply understand the value of PD-1 immune checkpoint inhibitor in pancreatic cancer and validly provide the evidence for treatment by means of performing a systematic review on the current status in the fields of the mechanism and application of anti-PD-1 in pancreatic cancer, associations with surgery, PD- 1-related side effects and prospections.展开更多
A consensus statement on the diagnosis and treatment of pancreatic exocrine insufficiency(PEI)after pancreatic surgery was developed based on the latest references,combined with China’s actual situation.More than 20 ...A consensus statement on the diagnosis and treatment of pancreatic exocrine insufficiency(PEI)after pancreatic surgery was developed based on the latest references,combined with China’s actual situation.More than 20 Chinese excellent experts participated in this work and contributed many thorough discussions.This consensus discusses the definition,epidemiology,diagnosis,treatment,and follow-up of PEI after pancreatic surgery.The authors hope this consensus will promote the standard procedure of diagnosis and treatment of PEI in China.展开更多
Background:Management of gastric leak after sleeve gastrectomy(SG)is challenging due to its unpredictable outcomes.We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outc...Background:Management of gastric leak after sleeve gastrectomy(SG)is challenging due to its unpredictable outcomes.We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting.Methods:To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry.A cumulative sum analysis was used to identify a fitting curve of gastric leak rate.The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes.The logistic regression analysis was conducted to determine the predictors of acute leaks.Results:A total of 78 cases of SG leaks were collected with an incidence of 0.5%(78/15,721)from this registry(6 patients who had the primary SG in non-participating centers).After accumulating 260 cases in a bariatric surgery center,the leak rate decreased to a stably low value of under 1.17%.The significant differences presented in sex,waist circumference,and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population(P=0.005,=0.026,<0.001,and=0.001,respectively).Moreover,83.1%(59/71)of the leakage was near the esophagogastric junction region.Leakage healed in 64(88.9%,64/72)patients.The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months,respectively.Acute leak(38/72,52.8%)was the predominant type with a cumulative reoperation rate>50%,whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment(P=0.013).Precise dissection in the His angle area was independently associated with a lower acute leak rate,whereas preservation≥2 cm distance from the His angle area was an independent risk factor.Conclusions:Male sex,elevated waist circumference,hypoproteinaemia,and type 2 diabetes are risk factors of gastric leaks after SG.Optimizing surgical techniques,including precise dissection of His angle area and preservation of smaller gastric fundus,should be suggested to prevent acute leaks.展开更多
Background:Pancreatic neuroendocrine tumor is a rare and heterogeneous entity,and approximately half of the patients harbored liver metastasis when initially diagnosed,whose prognosis is dismal.High-throughput sequenc...Background:Pancreatic neuroendocrine tumor is a rare and heterogeneous entity,and approximately half of the patients harbored liver metastasis when initially diagnosed,whose prognosis is dismal.High-throughput sequencing has largely uncovered the genomic features of pancreatic neuroendocrine tumor,but the genetic alterations in the metastatic cases remain relatively unclear,which we aimed to study.Methods:Pathologically confirmed well-differentiated pancreatic neuroendocrine tumor samples resected in our hospital from 2000 to 2019 were collected.We performed deep sequencing on the exome of 341 tumor-related genes,and compared the differences of genetic alterations between the metastatic and the non-metastatic cases,as well as between the primary and the paired liver metastatic tumors.Results:Sequencing data of 79 samples from 29 pancreatic neuroendocrine tumor patients were included into analysis.A total of 2,471 somatic variants were identified,75.5%of which were considered as low-abundance.NOTCH1 was the most frequently mutated gene,altered in 26(53.1%)pancreatic neuroendocrine tumor samples from 18(62.1%)patients.Compared with the non-metastatic pancreatic neuroendocrine tumors,the metastatic cases were discovered with more single nucleotide variants and copy number variations,indicating the increased genomic instability.In addition,among the paired metastatic cases,the primary and the metastatic lesions shared limited mutated genes.Conclusions:Through the targeted deep sequencing,we identified the intratumor,intraindividual,and interindividual heterogeneity in the pancreatic neuroendocrine tumor patients,particularly in the metastatic cases,bringing potential challenges for the current biopsy strategies in guiding clinical treatments.展开更多
基金supported by the Shanghai Sailing Program(No.21YF1407100)the China Postdoctoral Science Foundation(No.2021M690037)+1 种基金the National Natural Science Foundation of China(Nos.82103409 and 81773068)the National Key R&D Program of China(No.2019YFC1315902)。
文摘Basophils,which are considered as redundant relatives of mast cells and the rarest granulocytes in peripheral circulation,have been neglected by researchers in the past decades.Previous studies have revealed their vital roles in allergic diseases and parasitic infections.Intriguingly,recent studies even reported that basophils might be associated with cancer development,as activated basophils synthesize and release a variety of cytokines and chemokines in response to cancers.However,it is still subject to debate whether basophils function as tumor-protecting or tumor-promoting components;the answer may depend on the tumor biology and the microenvironment.Herein,we reviewed the role of basophils in cancers,and highlighted some potential and promising therapeutic strategies.
文摘Objective:Currently,pre-treatment prediction of patients with pancreatic neuroendocrine tumors with liver metastases(PNELM)receiving surufatinib treatment was unsatisfying.Our objective was to examine the association between radiological characteristics and efficacy/prognosis.Methods:We enrolled patients with liver metastases in the phase III,SANET-p trial(NCT02589821)and obtained contrast-enhanced computed tomography(CECT)images.Qualitative and quantitative parameters including hepatic tumor margins,lesion volumes,enhancement pattern,localization types,and enhancement ratios were evaluated.The progression-free survival(PFS)and hazard ratio(HR)were calculated using Cox’s proportional hazard model.Efficacy was analyzed by logistic-regression models.Results:Among 152 patients who had baseline CECT assessments and were included in this analysis,the surufatinib group showed statistically superior efficacy in terms of median PFS compared to placebo across various qualitative and quantitative parameters.In the multivariable analysis of patients receiving surufatinib(N=100),those with higher arterial phase standardized enhancement ratio-peri-lesion(ASER-peri)exhibited longer PFS[HR=0.039;95%confidence interval(95%CI):0.003−0.483;P=0.012].Furthermore,patients with a high enhancement pattern experienced an improvement in the objective response ratio[31.3%vs.14.7%,odds ratio(OR)=3.488;95%CI:1.024−11.875;P=0.046],and well-defined tumor margins were associated with a higher disease control rate(DCR)(89.3%vs.68.2%,OR=4.535;95%CI:1.285−16.011;P=0.019)compared to poorlydefined margins.Conclusions:These pre-treatment radiological features,namely high ASER-peri,high enhancement pattern,and well-defined tumor margins,have the potential to serve as predictive markers of efficacy in patients with PNELM receiving surufatinib.
基金funded by grants from the National Natural Science Foundation of China(82070588,82370577)High Level Creative Talents from Department of Public Health in Zhejiang Province(S2032102600032)+7 种基金National Key R&D Program of China(2023YFA1800801)supported in part by grants from the School of Medicine,University of Verona,Verona,Italysupported in part by the Southampton National Institute for Health and Care Research(NIHR)Biomedical Research Centre(NIHR203319)supported by the Robert W.Storr Bequest to the Sydney Medical Foundation,University of Sydneya National Health and Medical Research Council of Australia(NHMRC)Program Grant(APP1053206)Investigator and MRFF grants(APP2032407,NCRI000183,APP2016215,APP 2010795APP1196492)a Cancer Institute,NSW grant(2021/ATRG2028).
文摘Background and Objective:Obesity is a global health issue closely linked to multiple cardiovascular and metabolic conditions.The renaming of nonalcoholic fatty liver disease(NAFLD)to metabolic dysfunction-associated fatty liver disease(MAFLD)has sparked discussions about renaming nonalcoholic fatty pancreas disease(NAFPD).This narrative review explores the potential benefits and challenges of renaming NAFPD to metabolic dysfunction-associated fatty pancreas disease(MAFPD)and its potential clinical implications.Methods:The review employs a narrative approach,synthesizing existing literature and expert opinions to evaluate the rationale behind and the possible implications of renaming NAFPD to MAFPD.Key Content and Findings:NAFPD is increasingly recognized worldwide but lacks standardized diagnostic criteria,hindering its independent classification as a disease.Renaming NAFPD to MAFPD may enhance diagnostic accuracy,prognostic prediction,and personalized treatment strategies.It may also facilitate global epidemiological research,data sharing,and collaboration.Major challenges include establishing uniform diagnostic guidelines for promoting and educating about the newly proposed terminology.Conclusions:The proposed renaming from NAFPD to MAFPD may offer promising benefits despite challenges.It may also lead to improved management and understanding of the disease,potentially benefiting global healthcare strategies aimed at addressing obesity-related pancreatic complications.
文摘Objectives:We assess the incidence of exocrine pancreatic insufficiency(EPI)at different time points after pancreatic surgery and explore pancreatic enzyme replacement therapy’s(PERT)efficacy.Background:EPI is characterized by inadequate pancreatic enzymes,resulting in maldigestion and abdominal symptoms.EPI is a common postoperative complication of pancreatic surgery,yet often overlooked by surgeons.There is no clear answer to when EPI occurs after pancreatic surgery nor the duration of PERT after partial pancreatectomy.Methods:Benign or borderline pancreatic tumor patients undergoing surgeries were recruited between December 2020 and November 2021 from 10 medical centers in China.The EPI Questionnaire(EPI-Q)was performed at discharge,and 3-,6-,9-,and 12-month follow-ups to evaluate the occurrence of EPI.Statistical analyses were performed to identify the occurrence of EPI and explore PERT’s efficacy.Results:Of the 146 patients,105(71.9%)were female,and the median age was 49(range 16–78 years).Symptoms of EPI patients were most pronounced within 3 months post-surgery(15.7%),while most patients recovered after 1 year(96.9%).There was a negative correlation between symptom score and time since surgery.Lack of PERT in the 3-month post-surgery was associated with higher symptom scores in pancreatoduodenectomy(PD)patients,while not in distal pancreatectomy(DP)patients.Conclusions:Generally,the high-occurrence period for postoperative EPI is within 3 months after resection in patients with benign or borderline pancreatic tumors,and most will gradually recuperate with time.PERT can improve symptoms in PD patients,while reduced PERT duration may be considered for DP patients.
基金supported by grants from the Shanghai Municipal Health Commission Health Industry Clinical Research Project(No.201940019)National Natural Science Foundation of China(Nos.82273382,82272929,82103409,81972218,81972257,and 81827807)+5 种基金Shanghai ShenKang Hospital Development Centre Project(No.SHDC2020CR2017B)Program of Shanghai Academic/Technology Research Leader(No.23XD1400600)China Postdoctoral Science Foundation(No.2021M690037)Shanghai Sailing Program(No.21YF1407100),the Open Fund of the Key Laboratory of Hepatosplenic Surgery,Ministry of Education,Harbin,China(No.GPKF202302)Beijing Xisike Clinical Oncology Research Foundation(Nos.Y-2022METAZQN-0003,Y-HR2022MS-0251,and Y-HR2022QN-0085)Science and Technology Planning Project of Yunnan Province(No.202305AF150148).
文摘Background and Objective:Cachexia-induced skeletal muscle atrophy is a critical manifestation in Kirsten rat sarcoma viral oncogene homologue(KRAS)-mutant pancreatic cancer(PC)patients,predominantly characterized by a shift in metabolic equilibrium towards catabolism that accelerates protein degradation in myofibers and leads to muscle atrophy.This metabolic reprogramming not only supports tumor growth but also precipitates energy depletion in skeletal muscle tissues.Exploring these mechanisms reveals potential therapeutic targets in the metabolic and proteolytic pathways associated with KRAS-mutant PC.Methods:A comprehensive search for literature was conducted in PubMed,Web of Science,Google Scholar and other search engines up to May 21st,2024.Studies on PC models and patients were included.Key Content and Findings:The crosstalk between KRAS-mutant PC and skeletal muscle atrophy can be categorized into four principal domains:(I)KRAS-driven metabolic reprogramming in cancer cells leads to the depletion of muscle energy reserves,thereby influencing the reallocation of myofiber energy towards fueling cancer cell;(Ⅱ)KRAS-mutant cancer cells rely on nutrient-scavenging pathways,resulting in altered cytokine profiles,increased ubiquitin mRNA expression and autophagy-lysosome pathway,which facilitate myotube degradation and inhibit muscle regeneration,thereby disrupting muscular homeostasis and causing a one-way nutrient flux;(Ⅲ)tumor-induced oxidative stress inflicts damage on myotubes,highlighting the detrimental effects of reactive oxygen species on muscle structure;(Ⅳ)KRAS-mutant cancer cells remodulate immune cell dynamics within the tumor environment,thereby reshaping host immunity.Together,these findings illuminate the intricate interplay between KRAS-mutant PC and skeletal muscle atrophy,mapping the pathophysiological framework that is crucial for understanding sarcopenia and related disorders.Conclusions:This comprehensive analysis advances our understanding of the complex etiology of cancer cachexia and stimulates the development of targeted therapeutic strategies.
基金This study was supported by Technology Program of Zhejiang Province,China(2015C03049)
文摘Background:A growing body of evidence supports the use of laparoscopic pancreaticoduodenectomy(LPD)as an efficient and feasible surgical technique.However,few studies have investigated its applicability in pancreatic ductal adenocarcinoma(PDAC),and the long-term efficacy of LPD on PDAC remains unclear.This study aimed to compare the short-and long-term outcomes between LPD and open pancreaticoduodenectomy(OPD)for PDAC.Methods:The data of patients who had OPD or LPD for PDAC between January 2013 and September 2017 were retrieved.Their postoperative outcomes and survival were compared after propensity score matching.Results:A total of 309 patients were included.After a 2:1 matching,93 cases in the OPD group and 55 in the LPD group were identified.Delayed gastric emptying(DGE),particularly grade B/C DGE,occurred less frequently in the LPD group than in the OPD group(1.8%vs.36.6%,P<0.001;1.8%vs.22.6%,P=0.001).The overall complication rates were significantly lower in the LPD group than in the OPD group(49.1%vs.71.0%,P=0.008),whereas the rates of major complications were similar(10.9%vs.14.0%,P=0.590).In addition,the median overall survival was comparable between the two groups(20.0 vs.18.7 months,P=0.293).Conclusion:LPD was found to be technically feasible with efficacy similar to OPD for patients with PDAC.
文摘Objective: In 2015, the Chinese Pancreatic Association of the Chinese Society of Surgery of the Chinese Medical Association launched a national multicenter online system for registration of surgical treatment of pancreatic cancer in China, called China Pancreas Data Center (CPDC). With continued effort, the CPDC has developed over time. Herein, we report the general results of the CPDC from January 2016 to January 2020 to present the real-world situation of surgical treatment of pancreatic cancer in China.Methods: The data of the CPDC from January 2016 to January 2020 were retrieved and analyzed in this real-world study, including the data on patient demographics, comorbidities, diagnostic modalities, neoadjuvant treatment, surgical procedures, postoperative complications and treatment, pathological examinations, postoperative adjuvant treatment, survival, and risk factors.Results: A total of 13,595 cases from 70 centers in 28 provinces were retrieved for analysis. This study reported the largest cohort of patients who underwent surgical treatment for pancreatic cancer in China to date. More cases were derived from the Eastern regions, among which Shanghai, Beijing, and Zhejiang ranked in the top three. The peak age of the patients ranged from 60 to 69 years. The ratio of males to females was 1.5:1. Overall, 64.3% of the tumors were located in the head and neck of the pancreas, and 35.7% in the body and tail of the pancreas. Of the patients, 23.0% underwent positron-emission tomography-computed tomography, 21.6% underwent endoscopic ultrasound, and 4.8% underwent preoperative biopsy. Two percent of the patients underwent neoadjuvant treatment, while 68.9% underwent R0 surgical resection (margin free of tumor cells). Of the latter, 78.6% of the operations were open procedures, 12.6% were laparoscopic procedures, 2.9% were robotic procedures, and 3.7% were converted to open procedures. The in-hospital mortality rate after surgery was 0.4%. The incidence of grade 2 and grade 3 postoperative pancreatic fistulas was 25.5% and 2.5%, respectively. The incidence of complications based on the Clavien-Dindo classification was 17.9% of grade II, 4.3% of grade IIIa, 1% of grade IIIb, and 0.6% of grade IV. Of the patients, 28.9% underwent postoperative adjuvant chemotherapy. The 1-year, 2-year, and 3-year overall survival of these patients were 77%, 51%, and 38%, respectively. In the 8542 patients who underwent R0 resection, the 1-year, 2-year, and 3-year overall survival and disease-free survival were 77% , 54%, and 43%, and 68%, 49%, and 41%, respectively. The factors related to the prognosis of these patients were also identified after uni-and multi-variate analyses.Conclusion: The surgical quality, safety, and long-term survival of the patients in CPDC are similar to those of international high-volume pancreatic centers. However, neoadjuvant and postoperative adjuvant chemotherapy should be improved.
基金supported by the National Natural Science Foundation of China(Grant number,82141127).
文摘Many management strategies are available for pancreatic neuroendocrine neoplasms with liver metastases.However,a lack of biological,molecular,and genomic information and an absence of data from rigorous trials limit the validity of these strategies.This review presents the viewpoints from an international conference consisting of several expert working groups.The working groups reviewed a series of questions of particular interest to clinicians taking care of patients with pancreatic neuroendocrine neoplasms with liver metastases by reviewing the existing management strategies and literature,evaluating the evidence on which management decisions were based,developing internationally acceptable recommendations for clinical practice,and making recommendations for clinical and research endeavors.The review for each question will be followed by recommendations from the panel.
文摘Acute pancreatitis(AP)is a common acute abdominal condition of the digestive system.In recent years,treatment concepts,methods,and strategies for the diagnosis of AP have advanced,and this has played an important role in promoting the standardization of AP diagnosis and treatment and improving the treatment quality of AP patients.On the basis of previous guidelines and expert consensus,this guideline adopts an evidence-based,problem-based expression;synthesizes important clinical research data at home and abroad in the most recent 5 years;and forms 29 recommendations through multidisciplinary expert discussion,including diagnosis,treatment,and follow-up.It is expected to provide evidence support for the treatment of AP in the clinical setting in China.
基金supported by the National Natural Science Foundation of China(Grant No.82141104)National Natural Science Foundation of China(Grant No.82141102)Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences(Grant No.2021-I2M-1-002).
文摘The World Health Organization(WHO)2017 classifications for neuroendocrine neoplasms(NENs)subdivided grade 3 pancreatic neuroendocrine neoplasms(pNENs)into G3 well-differentiated pancreatic neuroendocrine tumors(G3 pNETs)and poorly differentiated pancreatic neuroendocrine carcinomas(pNECs),according to the mitotic count,Ki-67 index,and cell differentiation.As a new category,G3 pNETs remain a challenging group of tumors to manage by lacking large randomized trials and consensus to support its clinical practice.Therefore,the Chinese Pancreatic Surgery Association,Chinese Society of Surgery,Chinese Medical Association gathered experts in this field to formulate this consensus for the diagnosis and treatment of G3 pNETs.
基金This work was supported by the National Key R&D Program of China(No.2017YFC0112100)the Science and Technology Commission of Shanghai Municipality(No.17XD1401200).
文摘Objective: It remains unclear whether adjuvant chemoradiotherapy (CRT) improves survival outcome of pancreatic ductal adenocarcinoma (PDAC) patients after surgery. This study aimed to investigate the efficacy and safety of tegafur/gimeracil/oteracil (S-1)-based adjuvant concurrent chemoradiotherapy in resected PDAC patients with defined high-risk pathological features.Methods: We conducted a single-arm, prospective, and interventional study at Zhongshan Hospital Fudan University from December 2012 to December 2019 and the last follow-up was conducted in December 2021. This study was approved by the Ethics Committee of Zhongshan Hospital Fudan University on December 27, 2012 (approval No. B2012-139). Resected PDAC patients with high-risk pathological features, including positive resection margin, pathological T3-4N1-2M0 disease, peripancreatic fat invasion, microvascular invasion, and perineural invasion, were recruited. Primary endpoint was overall survival and secondary endpoints were disease-free survival, treatment toxicity, and 2-, 5-year survival rates.Results: A total of 54 patients were recruited. Mean age was 63.6 years old (±7.2). The distribution of T and N stages were 24.1% for T1, 46.3% for T2, 27.8% for T3, 1.9% for T4, 33.3% for N1, and 11.1% for N2. Seven patients had R1 resection. The median overall survival and disease-free survival were 27.1 and 13.7 months, respectively, while no fatal adverse events were recorded. Subgroup analyses showed differences in survival outcomes among patients with microvascular invasion, different N stages, and preoperative CA 19-9 levels. Further, a Cox proportional hazard model demonstrated associations of lymph node metastases, CA 19-9 level, and microvascular invasion with overall survival and disease-free survival.Conclusion: S-1 -based adjuvant CRT showed promising efficacy and manageable toxicity in resected PDAC patients with highrisk pathological features.
文摘The incidence of pancreatic cancer has been rising worldwide,and its clinical diagnosis and treatment remain a great challenge.To present the update and improvements in the clinical diagnosis and treatment of pancreatic cancer in recent years,Chinese Pancreatic Association,the Chinese Society of Surgery,Chinese Medical Association revised the Guidelines for the Diagnosis and Treatment of Pancreatic Cancer in China(2014)after reviewing evidence-based and problem-oriented literature published during 2015-2021,mainly focusing on highlight issues regarding diagnosis and surgical treatment of pancreatic cancer,conversion strategies for locally advanced pancreatic cancer,treatment of pancreatic cancer with oligo metastasis,adjuvant and neoadjuvant therapy,standardized processing of surgical specimens and evaluation of surgical margin status,systemic treatment for unresectable pancreatic cancer,genetic testing,as well as postoperative follow up of patients with pancreatic cancer.Forty recommendation items were finally proposed based on the above issues,and the quality of evidence and strength of recommendations were graded using the Grades of Recommendation,Assessment,Development,and Evaluation system.This guideline aims to standardize the clinical diagnosis and therapy,especially surgical treatment of pancreatic cancer in China,and further improve the prognosis of patients with pancreatic cancer.
基金Chinese Academy of Medical Sciences(CAMS)Initiative for Innovative Medicine(CAMS-I2M)2017-I2M-1-001 supported this study.
文摘Objective:The aim of this study is to investigate the current status of the diagnosis and treatment of patients with pancreatic neuroendocrine neoplasms(pNENs)undergoing surgery in China.Methods:This is a multicenter cross-sectional study performed in China.Data from patients with pNENs undergoing surgery at 33 high-volume medical centers,where the number of pancreatectomies exceeds 20 cases per year,were collected and analyzed between March 1,2016 and February 28,2017.Results:In total,392 patients with pNENs were enrolled.The male to female ratio was 1.4.The majority of patients were aged between 40 and 70 years.65.6%of the patients had non-functional tumors.Among those with functional tumors,the percentages of insulinomas,gastrinomas,glucagonomas,and vasoactive intestinal peptide-secreting tumors were 94.8%,1.5%,2.2%,and 1.5%,respectively.Multidisciplinary team(MDT)discussion was conducted for 39.0%of the patients.Minimally invasive surgery was performed on 31.1%of the 392 patients.The incidence of grade B/C pancreatic fistula formation was 4.4%.A total of 89.0%of the surgeries achieved R0 resection,and 41.6%of the tumors were well differentiated.Lymph node metastasis was present in 8.9%of the patients.The percentages of patients with grades G1,G2,and G3 disease were 49.2%,45.7%,and 5.1%,respectively.Conclusion:This multicenter cross-sectional study systematically presents the current status of the diagnosis and treatment of patients with pNENs undergoing surgery in China.MDT consultation for pNENs has not been widely implemented in China.Although the incidence of surgical complications is relatively low,minimally invasive procedures should be further promoted.This study shows us how to improve the outcomes of these patients.
基金National Natural Science Foundation of China(81702304,81773068).
文摘Pancreatic neuroendocrine tumors(pNETs)might present as part of a complex of hereditary(familial)syndromes caused by germline mutations such as multiple endocrine neoplasia type 1(MEN1),von Hippel-Lindau syndrome(VHL),tuberous sclerosis,and neurofibromatosis syndromes.Hereditary pNETs are frequently misdiagnosed because their presentation may mimic other more common diseases,resulting in diagnostic delays.Although non-operative(conservative)management could be advocated in select cases in most patients,hereby avoiding surgery without loss of oncological safety,some cases still need operative intervention before malignancy develops.The objective of this review is to address the most recent literature and the evidence it provides for the indications,timing and options of operative treatment for concomitant pNETs in hereditary tumor syndromes.Complete sequencing of the whole gene is recommended for suspected hereditary pNETs.Proven functional pNETs with hereditary tumor syndromes is a good indication for surgical treatment.Conservative management for MEN1 patients with a non-functional pNET of 2cm or smaller is associated with a low risk of malignant transformation and metastasis development.VHL-related pNETs patients with tumor size>1.5cm or a missense mutation or any mutation type in exon 3 may benefit from surgical intervention.The parenchyma-sparing surgical strategy should be preferentially performed whenever possible in all hereditary syndromes.The decision to recommend surgery to prevent malignant transformation and tumor spread,which is based on multidisciplinary expertise and the patient’s preference,should be balanced with operative mortality and morbidity.
文摘Objective: The aim of this study is to investigate the current status of pancreatic cancer patients undoing surgical treatment in China and to find ways to improve the survival of these patients in the future. Methods: This study is a national, multicenter, cross-sectional study in China. Information regarding pancreatic cancer patients undergoing surgical treatment from 34 high-volume tertiary IIIA level hospitals was collected and analyzed from the March 1, 2016 to the February 28, 2017. Results: In total, 2200 pancreatic cancer patients were enrolled from 34 tertiary IIIA level hospitals in 16 provinces across China. The male-to-female ratio was 1.5. More than 80% of the patients were between 50 and 70 years old. The top 4 symptoms were epigastric discomfort, abdominal pain, jaundice, and weight loss. Carbohydrate antigen 19-9 and carcinoembryonic antigen were elevated in 70.9% and 27.1% of patients, respectively. A multidisciplinary team (MDT) discussion was carried out for 35.0% of patients before surgery. The proportion of minimally invasive pancreatic surgeries was approximately 20%. A total of 83.4% of the operations achieved R0 resection, and the incidence of grade 3/4 postoperative complications was 7.7%. Only 13.4% of the patients received postoperative adjuvant chemotherapy. The percentage of pathological stage I tumors was only 24.5%. Conclusion: The majority of pancreatic cancer patients undergoing surgical resection in China are in an advanced stage. The MDT consultations for pancreatic cancer have not been widely carried out. R0 resection has been achieved in most cases, with relatively low incidence of serious complications, but minimally invasive pancreatic surgery should be further promoted. The application of postoperative chemotherapy remains low. This national, multicentre, cross-sectional study comprehensively presents the current status of pancreatic cancer patients undergoing surgical treatment and shows the road to improve survival of these patients in the future.
基金supported by the Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences(CIFMS)2017-I2M-1-001.
文摘Pancreatic neuroendocrine neoplasms(pNENs)are highly heterogeneous,and the management of pNENs patients can be intractable.To address this challenge,an expert committee was established on behalf of the Chinese Pancreatic Surgery Association,which consisted of surgical oncologists,gastroenterologists,medical oncologists,endocrinologists,radiologists,pathologists,and nuclear medicine specialists.By reviewing the important issues regarding the diagnosis and treatment of pNENs,the committee concluded evidence-based statements and recommendations in this article,in order to further improve the management of pNENs patients in China.
文摘Pancreatic ductal adenocarcinoma is the known kind of tumor biologically featured as high malignant degree, lack of effective methods for diagnosis and treatment, which reflects its unpleasant prognosis. Recently, with the breakthrough of burgeoning therapeutic methods, the flush of dawn for pancreatic cancer nearly arrives. Nowadays, besides surgery, neoadjuvant chemoradiotherapy, tumor vaccine therapy, and immunotherapy all show their active situation and obtain certain clinical efficacy, but that is still limited to pancreatic cancer. However, the appearance and development of programmed cell death-1 (PD-1) immune checkpoint inhibitor may final improve survival of pancreatic cancer. This article aims to deeply understand the value of PD-1 immune checkpoint inhibitor in pancreatic cancer and validly provide the evidence for treatment by means of performing a systematic review on the current status in the fields of the mechanism and application of anti-PD-1 in pancreatic cancer, associations with surgery, PD- 1-related side effects and prospections.
文摘A consensus statement on the diagnosis and treatment of pancreatic exocrine insufficiency(PEI)after pancreatic surgery was developed based on the latest references,combined with China’s actual situation.More than 20 Chinese excellent experts participated in this work and contributed many thorough discussions.This consensus discusses the definition,epidemiology,diagnosis,treatment,and follow-up of PEI after pancreatic surgery.The authors hope this consensus will promote the standard procedure of diagnosis and treatment of PEI in China.
基金ZTZ has received funding from the National Key Technologies R&D Program(No.2015BAI13B09)the Capital’s Funds for Health Improvement and Research(No.2020-1-2021)MYL has received funding from the Beijing Excellent Talents Training Funding Program(No.2018000021469G195).
文摘Background:Management of gastric leak after sleeve gastrectomy(SG)is challenging due to its unpredictable outcomes.We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting.Methods:To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry.A cumulative sum analysis was used to identify a fitting curve of gastric leak rate.The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes.The logistic regression analysis was conducted to determine the predictors of acute leaks.Results:A total of 78 cases of SG leaks were collected with an incidence of 0.5%(78/15,721)from this registry(6 patients who had the primary SG in non-participating centers).After accumulating 260 cases in a bariatric surgery center,the leak rate decreased to a stably low value of under 1.17%.The significant differences presented in sex,waist circumference,and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population(P=0.005,=0.026,<0.001,and=0.001,respectively).Moreover,83.1%(59/71)of the leakage was near the esophagogastric junction region.Leakage healed in 64(88.9%,64/72)patients.The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months,respectively.Acute leak(38/72,52.8%)was the predominant type with a cumulative reoperation rate>50%,whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment(P=0.013).Precise dissection in the His angle area was independently associated with a lower acute leak rate,whereas preservation≥2 cm distance from the His angle area was an independent risk factor.Conclusions:Male sex,elevated waist circumference,hypoproteinaemia,and type 2 diabetes are risk factors of gastric leaks after SG.Optimizing surgical techniques,including precise dissection of His angle area and preservation of smaller gastric fundus,should be suggested to prevent acute leaks.
基金supported by the Science and Technology Commission of Shanghai Municipality(No.19140901700).
文摘Background:Pancreatic neuroendocrine tumor is a rare and heterogeneous entity,and approximately half of the patients harbored liver metastasis when initially diagnosed,whose prognosis is dismal.High-throughput sequencing has largely uncovered the genomic features of pancreatic neuroendocrine tumor,but the genetic alterations in the metastatic cases remain relatively unclear,which we aimed to study.Methods:Pathologically confirmed well-differentiated pancreatic neuroendocrine tumor samples resected in our hospital from 2000 to 2019 were collected.We performed deep sequencing on the exome of 341 tumor-related genes,and compared the differences of genetic alterations between the metastatic and the non-metastatic cases,as well as between the primary and the paired liver metastatic tumors.Results:Sequencing data of 79 samples from 29 pancreatic neuroendocrine tumor patients were included into analysis.A total of 2,471 somatic variants were identified,75.5%of which were considered as low-abundance.NOTCH1 was the most frequently mutated gene,altered in 26(53.1%)pancreatic neuroendocrine tumor samples from 18(62.1%)patients.Compared with the non-metastatic pancreatic neuroendocrine tumors,the metastatic cases were discovered with more single nucleotide variants and copy number variations,indicating the increased genomic instability.In addition,among the paired metastatic cases,the primary and the metastatic lesions shared limited mutated genes.Conclusions:Through the targeted deep sequencing,we identified the intratumor,intraindividual,and interindividual heterogeneity in the pancreatic neuroendocrine tumor patients,particularly in the metastatic cases,bringing potential challenges for the current biopsy strategies in guiding clinical treatments.
