A recently published study(Xin et al.,Prog Biochem Biophys,2026,53(2):431-441.DOI:10.3724/j.pibb.2025.0508)addresses the therapeutic challenges of pancreatic ductal adenocarcinoma(PDAC)by innovatively developing an or...A recently published study(Xin et al.,Prog Biochem Biophys,2026,53(2):431-441.DOI:10.3724/j.pibb.2025.0508)addresses the therapeutic challenges of pancreatic ductal adenocarcinoma(PDAC)by innovatively developing an orally administered nanogene delivery system.Designed to achieve in situ,efficient delivery of chimeric antigen receptor(CAR)genes to tumor sites,this approach offers a novel strategy for CAR-macrophage(CAR-M)based immunotherapy.Its key highlights are as follows.展开更多
The development of pancreatic surgery in China has progressed remarkably over 7 decades.China initiated its pancreatic surgery journey in the 1950s,marked by the first pancreaticoduodenectomy performed by Zeng Xianjiu...The development of pancreatic surgery in China has progressed remarkably over 7 decades.China initiated its pancreatic surgery journey in the 1950s,marked by the first pancreaticoduodenectomy performed by Zeng Xianjiu in 1951.Early progress was hindered by technological limitations and fragmented practices,but the establishment of academic platforms such as the National Pancreatic Disease Symposia in the 1980s catalyzed standardized research and interdisciplinary collaboration.In 2006,Zhang Shengdao spearheaded China’s first Guidelines for the Diagnosis and Treatment of Severe Acute Pancreatitis.The 21st century has seen remarkable progress in pancreatic surgery,marked by the China-specific treatment guidelines,technological breakthroughs in laparoscopic and robotic surgical systems,and the increasing centralization of pancreatic surgery in high-volume medical centers.These synergistic advancements have collectively propelled a paradigm shift in contemporary cancer care.By 2022,China Pancreas Data Center reported a postoperative mortality rate of 0.4% and 3-year survival rates of 43% for resected pancreatic cancer,rivaling global benchmarks.China has also emerged as a leader in minimally invasive pancreatic surgery,with advancements in laparoscopic and robotic pancreatic surgery.Academic growth paralleled clinical progress:the Chinese Pancreatic Association,established in 2022,fosters global collaboration,evidenced by its 2024 annual conference attracting over 10,000 participants.Through technological innovation,centralized care models,and international partnerships,China continues to redefine its role in advancing pancreatic surgery.展开更多
Background:Minimally invasive distal pancreatectomy(MIDP)is increasingly being used,although its oncologic safety for pancreatic ductal adenocarcinoma(PDAC)remains controversial.In Japan,MIDP for PDAC has limited endo...Background:Minimally invasive distal pancreatectomy(MIDP)is increasingly being used,although its oncologic safety for pancreatic ductal adenocarcinoma(PDAC)remains controversial.In Japan,MIDP for PDAC has limited endorsement due to insufficient data.This study aimed to compare the perioperative and long-term outcomes of open distal pancreatectomy(ODP)and MIDP for PDAC.Methods:We retrospectively analyzed patients with resectable pancreatic body and tail cancer treated with ODP or MIDP(laparoscopic or robotic)between January 2007 and July 2022.The surgical procedures(ODP and MIDP)were compared and the patient characteristics,perioperative outcomes,and long-term outcomes were analyzed.We also compared the outcomes of patients with neoadjuvant chemotherapy(NAC)and without NAC.Results:A total of 72 distal pancreatectomies were performed(37 ODPs and 35 MIDPs).In the upfront group,MIDP resulted in significantly less blood loss than ODP(P<0.01),despite similar operative time.There was no statistically significant difference in the 2-year recurrence-free survival(RFS)rates between ODP and MIDP(39.7%vs.57.8%,P=0.60)or in the overall survival(OS)rates(66.7%vs.74.1%,P=0.43).Similarly,in the NAC group,MIDP resulted in significantly less blood loss than ODP(P=0.01);ODP and MIDP had similar 2-year RFS rates(41.7%and 60.0%,P=0.75)and OS rates(50.0%and 70.0%,P=0.36).The interval from surgery to adjuvant chemotherapy initiation did not significantly differ between the ODP and MIDP subgroups in both the upfront group(P=0.13)and the NAC group(P=0.14).The incidence of recurrence was 64.8%for ODP and 42.8%for MIDP(P=0.06).Both procedures showed similar distributions of local and distant recurrence.Conclusions:MIDP caused less blood loss and had similar oncologic safety compared with ODP.MIDP could become a feasible,minimally invasive option with sufficient oncologic safety for pancreatic body and tail cancers.展开更多
The activation of pancreatic stellate cells(PSCs)and the secretion of inflammatory factors play critical roles in the development of pancreatic fibrosis.While gambogic acid(GA),a flavonoid with anti-tumor properties,h...The activation of pancreatic stellate cells(PSCs)and the secretion of inflammatory factors play critical roles in the development of pancreatic fibrosis.While gambogic acid(GA),a flavonoid with anti-tumor properties,has been studied,its role in this process remains unclear.This study demonstrated that GA promoted YAP1 degradation and reduced its nuclear localization,thereby inhibiting PSC activation and the progression of pancreatic fibrosis.GA inhibited PSC proliferation,decreasedα-smooth muscle actin(α-SMA)expression,and reduced lipid droplets in LTC14 and primary mouse PSCs(mPSCs).Additionally,GA suppressed the expression of inflammatory factors[nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3),nuclear factor erythroid 2-related factor 2(NRF2),interleukin-6(IL-6),tumor necrosis factorα(TNF-α),and nuclear factorκB(NF-κB)]in PSCs and counteracted the transforming growth factor(TGF)-β-induced increase in these proteins.GA also reduced collagenΙand tissue inhibitor of metalloproteinase-1(TΙMP1)expression,thereby attenuating fibrosis.Mechanistically,GA decreased YAP1 expression and nuclear translocation and reversed TGF-β-induced YAP1 upregulation.YAP1 overexpression abrogated GA’s inhibitory effects on PSC activation and inflammation.Furthermore,GA activated the Hippo pathway,increased phosphorylated(p)-LATS1 and p-YAP levels,and promoted ubiquitin-mediated YAP1 degradation.In vivo studies confirmed that GA inhibited dibutyltin dichloride(DBTC)-induced pancreatic fibrosis via suppressing YAP1 and NF-κB in BALB/c mice.In conclusion,GA activates the Hippo pathway and promotes YAP1 translocation to the cytoplasm,leading to its degradation and subsequent inhibition of PSC activation and fibrosis.These findings highlight the critical role of ubiquitin-mediated YAP1 degradation in regulating PSC activity and offer novel insights into the therapeutic potential of GA for treating pancreatic fibrosis.展开更多
BACKGROUND Endoscopic ultrasound(EUS)is crucial for diagnosing solid pancreatic lesions,especially pancreatic ductal adenocarcinoma(PDAC),a highly aggressive cancer which represents the majority with a prevalence of a...BACKGROUND Endoscopic ultrasound(EUS)is crucial for diagnosing solid pancreatic lesions,especially pancreatic ductal adenocarcinoma(PDAC),a highly aggressive cancer which represents the majority with a prevalence of approximately 85%.AIM To identify EUS features that differentiate PDAC from other lesions such as neuroendocrine tumors(NETs)and helping in the differential diagnosis,by analyzing a large sample of solid pancreatic lesions.METHODS This observational,retrospective,multicenter study analyzed the endosonographic characteristics of 761 patients with a radiological diagnosis of solid pancreatic lesion,who underwent pancreatic EUS for typing and staging with needle biopsies between 2015 and 2023.General patient characteristics(age and sex)and solid lesion features were collected and described,such lesion size(Bmode),vessel involvement(compression or invasion),ductal dilation,lymphadenopathy,echogenicity,echopattern,margin regularity,multifocality,internal vascularization and elastography.Subsequently,a predictive analysis was performed through univariate and multivariate logistic regression to identify predictive features for PDAC or NET diagnoses.RESULTS Our study enrolled 761 patients,predominantly male with a mean age of 68.6.PDACs were generally larger(mean 33 mm×27 mm),often had irregular margins,and displayed significant upstream ductal dilation.Hypoechogenicity was common across malignant lesions.In contrast,NETs were smaller(mean 20 mm×17 mm)and typically had regular margins with multiple lesions.Vascular involvement,although predominant in PDAC,is a common feature of all malignant neoplasms.Multifocality,however,although a rare finding,is more typical of NETs and metastases,and practically absent in the remaining lesions.Predictive analyses showed that ductal dilation and irregular margins were the most significant predictors for PDAC[odds ratio(OR)=5.75 and 3.83],with hypoechogenicity,heterogeneous echopattern and lymphadenopathies also highly significant(OR=3.51,2.56 and 1.99).These features were inversely associated with NETs,with regular margins and absence of ductal involvement or lymphadenopathies(OR=0.24,0.86 and 0.45 respectively),as already shown by the descriptive analysis.Finally,age,despite achieving statistical significance,lacks clinical value given an OR trending towards 1.CONCLUSION This study provides a comprehensive overview of EUS features for solid pancreatic lesions,identifying distinct features like upstream ductal dilation and irregular margins for PDAC vs regular margins for NETs as strong diagnostic predictors.These findings enhance the understanding of pancreatic pathologies,offering valuable insights for improved differential diagnosis and clinical management,especially in complex cases.Further prospective studies could build on these results.展开更多
BACKGROUND Pancreatic surgery has markedly evolved during the past several years with the development of minimally invasive techniques such as laparoscopy.pancreaticojejunostomy(PJ),also known as pancreatoenterostomy,...BACKGROUND Pancreatic surgery has markedly evolved during the past several years with the development of minimally invasive techniques such as laparoscopy.pancreaticojejunostomy(PJ),also known as pancreatoenterostomy,is a critical step in surgical reconstruction after pancreatic resection.However,the laparoscopic performance of PJ presents additional technical challenges,especially in achieving a secure anastomosis while preserving the integrity of pancreatic tissue.AIM To evaluate the effectiveness and safety of binding and interlocking PJ(BIPJ)as a novel technique in laparoscopic pancreatic surgery.METHODS Data of patients who underwent laparoscopic pancreatic surgery from 2018 to 2023 were obtained from the hepatobiliary and pancreatic surgery database of the Second Affiliated Hospital of Zhejiang University School of Medicine and retrospectively analyzed.According to the different PJ methods used during surgery,the patients were divided into two groups:The BIPJ group and the ductto-mucosa PJ(DMPJ)group.RESULTS BIPJ was performed in 33 patients,and DMPJ was performed in 34 patients.The operative time was significantly shorter in the BIPJ group(median,340 minutes;interquartile range,310-350)than in the DMPJ group(median,388 minutes;interquartile range,341-464)(P=0.004).No significant differences were found between the DMPJ and BIPJ groups in terms of the rates of pancreatic fistula,intra-abdominal hemorrhage,intra-abdominal abscess,postoperative biliary fistula,reoperation,or postoperative hospital stay.CONCLUSION The suitability of laparoscopic PJ for all pancreatic textures,ability to perform full laparoscopy,shorter operation time,and comparable safety with traditional PJ make BIPJ a promising option for both surgeons and patients.展开更多
High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and itdoes not exhibit mass lesions. It is suspected based on changes in the mainpancreatic duct in magnetic resonance cholangiopancreatograph...High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and itdoes not exhibit mass lesions. It is suspected based on changes in the mainpancreatic duct in magnetic resonance cholangiopancreatography. Sometimesonly an unclear duct shows in magnetic resonance cholangiopancreatographywith no focal strictures and upstream dilatation of the main pancreatic duct. Serialpancreatic juice cytology is valuable in diagnosis of those patients.展开更多
General information Hepatobiliary&Pancreatic Diseases International is a journal published bimonthly in the English language by the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou,China.W...General information Hepatobiliary&Pancreatic Diseases International is a journal published bimonthly in the English language by the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou,China.We welcome original research articles,review articles,editorials,and others from any part of the world.Manuscripts are reviewed by members of the international editorial board and our expert peer reviewers,then either accepted for publication or rejected by the chief editor.Manuscripts should.展开更多
Objectives:The five-year survival rate for pancreatic cancer is notably low,posing a significant challenge to patient health.The primary treatments are radiotherapy and chemotherapy,sometimes combined with targeted th...Objectives:The five-year survival rate for pancreatic cancer is notably low,posing a significant challenge to patient health.The primary treatments are radiotherapy and chemotherapy,sometimes combined with targeted therapy;however,their clinical benefits are limited.Therefore,developing new models to evaluate the therapeutic potential of novel molecules is essential.Fingolimod and Dimethyl Fumarate(DMF),currently used to treat multiple sclerosis,have recently been shown to have anti-cancer effects in several preclinical tumor models.This study aims to evaluate the therapeutic potential of Fingolimod and DMF in pancreatic cancer by investigating their respective in vitro cytotoxicity and in vivo antitumor effects.Methods:In this study,we evaluated for the first time these two drugs in pancreatic preclinical models in vitro using 3D spheroid tumor models and in vivo,which are compared to two standard-of-care consisting of Gemcitabine and Erlotinib.Results:In vitro,both Fingolimod and DMF induced cytotoxicity in spheroids from two pancreatic cell lines.Additionally,Fingolimod and DMF displayed anticancer effects in two subcutaneous xenograft models using PANC-1 and CFPAC-1 cells.Conclusions:Although the responses observed with Fingolimod and DMF were similar to those of Gemcitabine and Erlotinib,these findings indicate a potential emerging interest in Fingolimod and DMF for the treatment of pancreatic cancer.However,further work is still necessary to fully characterize how these drugs affect tumor progression.展开更多
Pancreatic cancer,specifically pancreatic ductal adenocarcinoma(PDAC),ranks among the most prevalent malignancies and is a leading cause of cancer-related mortality worldwide.Therefore,there is an urgent need to ident...Pancreatic cancer,specifically pancreatic ductal adenocarcinoma(PDAC),ranks among the most prevalent malignancies and is a leading cause of cancer-related mortality worldwide.Therefore,there is an urgent need to identify novel anti-pancreatic cancer agents.This study reports a newly identified homogeneous polysaccharide,designated ESPPW,isolated from Arthrospira platensis(A.platensis).The molecular weight of ESPPW is estimated at 356 kDa,and it consists predominantly of glucose and rhamnose,with minor amounts of mannose,glucuronic acid,galacturonic acid,galactose,xylose,arabinose,and fucose.ESPPW inhibits the proliferation and migration of PDAC cells both in vitro and in vivo.Mechanistic investigations reveal that ESPPW induces apoptosis through activation of caspase-3 and is associated with upregulation of the tumor-suppressor protein p53.Notably,treatment with 2.8 nmol·L^(-1) of ESPPW leads to significant time-dependent downregulation of galectin-3(Gal-3)and glypican-6(GPC-6).These findings are corroborated by immunohistochemical analysis of tumor xenograft tissues.Furthermore,overexpression of Gal-3 and GPC-6 reverses the pro-apoptotic effect of ESPPW,as indicated by restored cycle regulatory proteins(CDK2)expression.In conclusion,these data demonstrate that ESPPW suppresses PDAC cell growth by promoting apoptosis and disrupting the functional activity of Gal-3 and GPC-6.展开更多
Radiofrequency ablation(RFA),particularly endoscopic ultrasound-guided RFA(EUS-RFA),has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer,especially in patients with locally adv...Radiofrequency ablation(RFA),particularly endoscopic ultrasound-guided RFA(EUS-RFA),has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer,especially in patients with locally advanced or unresectable disease.This review outlines recent technological developments in EUS-RFA,including innovations in energy delivery systems,probe design,and real-time thermal monitoring,which have improved the precision and safety of the procedure.Clinical studies combining EUS-RFA with chemotherapy have demonstrated encouraging outcomes,with improvements in overall survival,progression-free survival,tumor necrosis,and symptom control compared to chemotherapy alone.Additionally,RFA-induced tumor antigen release and modulation of the tumor microenvironment suggest a potential synergistic role with immunotherapy.Despite its promise,the widespread adoption of EUS-RFA is limited by a lack of large-scale randomized controlled trials and standardized treatment protocols.展开更多
Objectives:Pancreatic cancer(PC)is characterized by poor prognosis due to its limited treatment choices and delayed detection.S100A14 has been implicated in tumor progression,yet its regulatory hierarchy and functiona...Objectives:Pancreatic cancer(PC)is characterized by poor prognosis due to its limited treatment choices and delayed detection.S100A14 has been implicated in tumor progression,yet its regulatory hierarchy and functional interplay in PC remain unclear.This study aimed to define the role of S100A14 in PC progression.Methods:Integrated bioinformatic analyses of TCGA-PAAD and GSE22780 datasets identified candidate hub genes.Prognostic relevance was assessed via Kaplan-Meier and ROC analyses.Functional experiments were performed in PANC-1 and BxPC-3 cells,including qRT-PCR,CCK-8 assay,Western blotting,Transwell assay,and apoptosis assay.Co-immunoprecipitation(Co-IP)was used to verify S100A14-S100A16 interaction.CHX chase and dual-luciferase assays were employed to assess protein stability and transcriptional activity.Results:S100A14 was markedly upregulated in PC tissues and cell lines and identified as a key prognostic gene.Silencing S100A14 suppressed EMT,proliferation,invasion,and migration,while reversing S100A16-mediated p53 inhibition and enhancing apoptosis.Mechanistically,Co-IP assay confirmed the protein interaction between S100A14 and S100A16;S100A14 stabilized S100A16 protein through post-translational modification without transcriptional regulation;the S100A14/S100A16 axis reduced p53 protein stability and inhibited its transcriptional activity as well as the downstream p21 expression.Critically,knockdown of S100A14 abrogated the pro-metastatic phenotype of cancer cells.Conclusion:This study identifies S100A14 promotes PC progression by stabilizing S100A16 and suppressing the tumor-suppressive p53/p21 pathway;knockdown of S100A14 can reverse the above effects,restore p53 function,and enhance cancer cell apoptosis.Targeting the S100A14/S100A16/p53 regulatory axis could represent a promising therapeutic approach for PC.展开更多
A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incisio...A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incision plus one-port LPD(SILPD+1)to minimize post-operative pain,improve convalescence,and provide a more pleas-ing cosmetic outcome[1,2].Additionally,some skilled surgeons have claimed that laparoscopic duodenum-preserving complete pancreatic head resections(LDPPHR)result in less trauma and en-hanced quality of life[3,4].However,LDPPHR is still challenging because of its lengthy learning curve and"sword-fighting"impact.Additionally,there has not been any global reporting on the suit-ability of single-incision plus one-port DPPHR with pancreaticogas-trostomy(SILDPPHR-T+1)in place of SILPD+1.This study aimed to illustrate the SILDPPHR-T+1 procedure specifics for a patient with pancreatic head intraductal papillary mucinous neoplasm(IPMN)(main pancreatic duct type)(MD-IPMN).展开更多
Intrapancreatic fat deposition(IPFD)has garnered increasing attention in recent years.The prevalence of IPFD is relatively high and associated with factors such as obesity,age,and sex.However,the pathophysiological me...Intrapancreatic fat deposition(IPFD)has garnered increasing attention in recent years.The prevalence of IPFD is relatively high and associated with factors such as obesity,age,and sex.However,the pathophysiological mechanisms underlying IPFD remain unclear,with several potential contributing factors,including oxida-tive stress,alterations in the gut microbiota,and hormonal imbalances.IPFD was found to be highly correlated with the occurrence and prognosis of exocrine pan-creatic diseases.Although imaging techniques remain the primary diagnostic approach for IPFD,an expanding array of biomarkers and clinical scoring systems have been identified for screening purposes.Currently,effective treatments for IPFD are not available;however,existing medications,such as glucagon-like peptide-1 receptor agonists,and new therapeutic approaches explored in animal models have shown considerable potential for managing this disease.This paper reviews the pathogenesis of IPFD,its association with exocrine pancreatic disea-ses,and recent advancements in its diagnosis and treatment,emphasizing the significant clinical relevance of IPFD.展开更多
Irreversible electroporation is a promising non-thermal ablation method that has been shown to increase overall survival in locally advanced pancreatic cancer in some studies.However,higher quality studies with proper...Irreversible electroporation is a promising non-thermal ablation method that has been shown to increase overall survival in locally advanced pancreatic cancer in some studies.However,higher quality studies with proper controls and randomization are required to establish its superiority when added with neoadjuvant chemotherapy over the current management of choice,which is chemotherapy alone.Further studies are required before establishment of any survival benefit in metastatic pancreatic carcinoma,and such evidence is lacking at present.展开更多
Pancreatic cancer is one of the solid tumors with the worst prognosis.Five-year survival rate is less than 10%.Surgical resection is the only potentially curative treatment,but the tumor is often diagnosed at an advan...Pancreatic cancer is one of the solid tumors with the worst prognosis.Five-year survival rate is less than 10%.Surgical resection is the only potentially curative treatment,but the tumor is often diagnosed at an advanced stage of the disease and surgery could be performed in a very limited number of patients.Moreover,surgery is still associated with high post-operative morbidity,while other therapies still offer very disappointing results.This article reviews every aspect of pancreatic cancer,focusing on the elements that can improve prognosis.It was written with the aim of describing everything you need to know in 2021 in order to face this difficult challenge.展开更多
BACKGROUND The treatment strategy for pancreatic pseudocysts(PPC)is comprehensive and warrants multidisciplinary participation.However,at present,the treatment concepts for PPC are inconsistent.Moreover,the timing of ...BACKGROUND The treatment strategy for pancreatic pseudocysts(PPC)is comprehensive and warrants multidisciplinary participation.However,at present,the treatment concepts for PPC are inconsistent.Moreover,the timing of interventional therapy is unclear,and complication management is insufficient.Therefore,the deve-lopment of a multidisciplinary expert consensus on PPC is warranted.At present,endoscopic treatment is recommended for managing PPC in American Society for Gastrointestinal Endoscopy guideline and Chinese Consensus guidelines.CASE SUMMARY In this study,we present a rare case of PPC identified by endoscopy and imaging examination,and successfully managed by endoscopic and percutaneous dra-inage.In detail,an obese patient with a history of recurrent pancreatitis presents an irregular,elliptical cystic low-density shadow in the pancreatic region.En-doscopic ultrasound combined with double knife incision technique was used to endoscopic drainage,resulting in a favorable prognosis.CONCLUSION Ultrasound-guided endoscopic drainage for the management of PPC may provide additional insights to current clinical guidelines.展开更多
BACKGROUND As a heterogeneous group of lesions,pancreatic cystic lesions(PCLs)vary enormously in malignant potential,mandating different treatment strategies.Despite significant advances in diagnostic imaging and labo...BACKGROUND As a heterogeneous group of lesions,pancreatic cystic lesions(PCLs)vary enormously in malignant potential,mandating different treatment strategies.Despite significant advances in diagnostic imaging and laboratory tests,the accurate diagnosis of PCLs remains challenging,leading to overtreatment or delayed/missed surgical timing in patients with PCLs.CASE SUMMARY We present a case of a 64-year-old female patient in whom an asymptomatic,incidental cystic mass was found in the pancreatic tail on a routine abdominal ultrasound.After a comprehensive work-up with laboratory examinations,contrast-enhanced computed tomography,magnetic resonance imaging,and magnetic resonance cholangiopancreatography,a pancreatic pseudocyst was suspected.Subsequent endoscopic ultrasound with fine-needle aspiration and needle-based confocal laser endomicroscopy supported a benign diagnosis.Follow-up computed tomography and magnetic resonance imaging examinations five months later showed significant cyst shrinkage without any abnormalities.However,three years after being lost to follow-up,the patient was readmitted and diagnosed with pancreatic adenocarcinoma with multiple metastases,suggesting that the initial lesion was a mucinous cystic neoplasm misdiagnosed as a pan-creatic pseudocyst.CONCLUSION Comprehensive integration of all available information(e.g.,cyst features,abnormal imaging findings,cyst biochemistry,clinical history,and patient demographics)rather than over-reliance on imaging or endoscopic findings is pivotal to diagnosing PCLs,and patients with concerning features should undergo strict surveillance.展开更多
Pancreatic carcinoma is one of the most lethal malignancies and has a dismal prognosis.However,advances in diagnostic modalities and better multidisciplinary management have contributed to improved survival in these p...Pancreatic carcinoma is one of the most lethal malignancies and has a dismal prognosis.However,advances in diagnostic modalities and better multidisciplinary management have contributed to improved survival in these patients.Of late,various recurrence patterns have been observed;the most common of them being distant metastasis followed by the pancreatic bed and lymph node recurrence.Recurrence in the remnant pancreas is on the rise due to improved survival in patients who previously underwent surgery for pancreatic cancer.Total remnant pancreatectomy is an appealing option in resectable remnant pancreatic carcinoma without distant metastasis.It is an entity showing an increasing incidence and demanding further in-depth studies to elucidate the exact pathological mechanism and to establish appropriate management protocols.展开更多
BACKGROUND Pancreatic fluid leakage is a rare complication of pancreatic cancer and often requires drainage when conservative therapy fails.Endoscopic,percutaneous,and surgical drainage are options.Minimally invasive ...BACKGROUND Pancreatic fluid leakage is a rare complication of pancreatic cancer and often requires drainage when conservative therapy fails.Endoscopic,percutaneous,and surgical drainage are options.Minimally invasive endoscopic procedures are generally considered the first-line treatment,with either a transpapillary approach or an endoscopic ultrasound-guided transmural approach selected depending on the case.Various dilators are used to dilate tracts to the leakage site.However,reports of dilation through a rigid trans-tumoral tract using a drill dilator remain extremely rare.CASE SUMMARY A 74-year-old woman with pancreatic body and tail cancer developed fever and left-sided chest pain after multiple courses of chemotherapy.Computed tomography revealed fluid accumulation around the pancreatic tail and spleen along with a left pleural effusion.The effusion was diagnosed as reactive secondary to pancreatic fluid leakage.Endoscopic retrograde cholangiopancreatography identified irregular stenosis of the main pancreatic duct in the pancreatic body.Distal to the stenosis,the main ductal structure was nearly obliterated by the tumor.The contrast medium had leaked into the pancreatic fluid leakage area through several fine,disrupted ductal structures.The guidewire was successfully advanced through an extremely fine tract that was not the main contrast-filling route.Standard dilators failed to expand the rigid trans-tumoral tract.A second endoscopic retrograde cholangiopancreatography using a drill dilator successfully expanded the trans-tumoral tract,enabling endoscopic nasopancreatic drainage tube placement.Subsequently,the pancreatic fluid leakage and pleural effusion resolved.CONCLUSION Even in rigid trans-tumoral tracts,the use of a drill dilator can facilitate successful tract expansion,enabling effective drainage.展开更多
文摘A recently published study(Xin et al.,Prog Biochem Biophys,2026,53(2):431-441.DOI:10.3724/j.pibb.2025.0508)addresses the therapeutic challenges of pancreatic ductal adenocarcinoma(PDAC)by innovatively developing an orally administered nanogene delivery system.Designed to achieve in situ,efficient delivery of chimeric antigen receptor(CAR)genes to tumor sites,this approach offers a novel strategy for CAR-macrophage(CAR-M)based immunotherapy.Its key highlights are as follows.
文摘The development of pancreatic surgery in China has progressed remarkably over 7 decades.China initiated its pancreatic surgery journey in the 1950s,marked by the first pancreaticoduodenectomy performed by Zeng Xianjiu in 1951.Early progress was hindered by technological limitations and fragmented practices,but the establishment of academic platforms such as the National Pancreatic Disease Symposia in the 1980s catalyzed standardized research and interdisciplinary collaboration.In 2006,Zhang Shengdao spearheaded China’s first Guidelines for the Diagnosis and Treatment of Severe Acute Pancreatitis.The 21st century has seen remarkable progress in pancreatic surgery,marked by the China-specific treatment guidelines,technological breakthroughs in laparoscopic and robotic surgical systems,and the increasing centralization of pancreatic surgery in high-volume medical centers.These synergistic advancements have collectively propelled a paradigm shift in contemporary cancer care.By 2022,China Pancreas Data Center reported a postoperative mortality rate of 0.4% and 3-year survival rates of 43% for resected pancreatic cancer,rivaling global benchmarks.China has also emerged as a leader in minimally invasive pancreatic surgery,with advancements in laparoscopic and robotic pancreatic surgery.Academic growth paralleled clinical progress:the Chinese Pancreatic Association,established in 2022,fosters global collaboration,evidenced by its 2024 annual conference attracting over 10,000 participants.Through technological innovation,centralized care models,and international partnerships,China continues to redefine its role in advancing pancreatic surgery.
文摘Background:Minimally invasive distal pancreatectomy(MIDP)is increasingly being used,although its oncologic safety for pancreatic ductal adenocarcinoma(PDAC)remains controversial.In Japan,MIDP for PDAC has limited endorsement due to insufficient data.This study aimed to compare the perioperative and long-term outcomes of open distal pancreatectomy(ODP)and MIDP for PDAC.Methods:We retrospectively analyzed patients with resectable pancreatic body and tail cancer treated with ODP or MIDP(laparoscopic or robotic)between January 2007 and July 2022.The surgical procedures(ODP and MIDP)were compared and the patient characteristics,perioperative outcomes,and long-term outcomes were analyzed.We also compared the outcomes of patients with neoadjuvant chemotherapy(NAC)and without NAC.Results:A total of 72 distal pancreatectomies were performed(37 ODPs and 35 MIDPs).In the upfront group,MIDP resulted in significantly less blood loss than ODP(P<0.01),despite similar operative time.There was no statistically significant difference in the 2-year recurrence-free survival(RFS)rates between ODP and MIDP(39.7%vs.57.8%,P=0.60)or in the overall survival(OS)rates(66.7%vs.74.1%,P=0.43).Similarly,in the NAC group,MIDP resulted in significantly less blood loss than ODP(P=0.01);ODP and MIDP had similar 2-year RFS rates(41.7%and 60.0%,P=0.75)and OS rates(50.0%and 70.0%,P=0.36).The interval from surgery to adjuvant chemotherapy initiation did not significantly differ between the ODP and MIDP subgroups in both the upfront group(P=0.13)and the NAC group(P=0.14).The incidence of recurrence was 64.8%for ODP and 42.8%for MIDP(P=0.06).Both procedures showed similar distributions of local and distant recurrence.Conclusions:MIDP caused less blood loss and had similar oncologic safety compared with ODP.MIDP could become a feasible,minimally invasive option with sufficient oncologic safety for pancreatic body and tail cancers.
基金supported by the Fundamental Research Funds for the Central Universities (No. 2632024TD07).
文摘The activation of pancreatic stellate cells(PSCs)and the secretion of inflammatory factors play critical roles in the development of pancreatic fibrosis.While gambogic acid(GA),a flavonoid with anti-tumor properties,has been studied,its role in this process remains unclear.This study demonstrated that GA promoted YAP1 degradation and reduced its nuclear localization,thereby inhibiting PSC activation and the progression of pancreatic fibrosis.GA inhibited PSC proliferation,decreasedα-smooth muscle actin(α-SMA)expression,and reduced lipid droplets in LTC14 and primary mouse PSCs(mPSCs).Additionally,GA suppressed the expression of inflammatory factors[nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3),nuclear factor erythroid 2-related factor 2(NRF2),interleukin-6(IL-6),tumor necrosis factorα(TNF-α),and nuclear factorκB(NF-κB)]in PSCs and counteracted the transforming growth factor(TGF)-β-induced increase in these proteins.GA also reduced collagenΙand tissue inhibitor of metalloproteinase-1(TΙMP1)expression,thereby attenuating fibrosis.Mechanistically,GA decreased YAP1 expression and nuclear translocation and reversed TGF-β-induced YAP1 upregulation.YAP1 overexpression abrogated GA’s inhibitory effects on PSC activation and inflammation.Furthermore,GA activated the Hippo pathway,increased phosphorylated(p)-LATS1 and p-YAP levels,and promoted ubiquitin-mediated YAP1 degradation.In vivo studies confirmed that GA inhibited dibutyltin dichloride(DBTC)-induced pancreatic fibrosis via suppressing YAP1 and NF-κB in BALB/c mice.In conclusion,GA activates the Hippo pathway and promotes YAP1 translocation to the cytoplasm,leading to its degradation and subsequent inhibition of PSC activation and fibrosis.These findings highlight the critical role of ubiquitin-mediated YAP1 degradation in regulating PSC activity and offer novel insights into the therapeutic potential of GA for treating pancreatic fibrosis.
基金Supported by the Italian Ministry of Health-Current research IRCCS(Funds Dedicated to the Research of the Gastroenterology and Digestive Endoscopy Unit,Fondazione IRCCS Ca’Granda,Ospedale Maggiore Policlinico,Milano).
文摘BACKGROUND Endoscopic ultrasound(EUS)is crucial for diagnosing solid pancreatic lesions,especially pancreatic ductal adenocarcinoma(PDAC),a highly aggressive cancer which represents the majority with a prevalence of approximately 85%.AIM To identify EUS features that differentiate PDAC from other lesions such as neuroendocrine tumors(NETs)and helping in the differential diagnosis,by analyzing a large sample of solid pancreatic lesions.METHODS This observational,retrospective,multicenter study analyzed the endosonographic characteristics of 761 patients with a radiological diagnosis of solid pancreatic lesion,who underwent pancreatic EUS for typing and staging with needle biopsies between 2015 and 2023.General patient characteristics(age and sex)and solid lesion features were collected and described,such lesion size(Bmode),vessel involvement(compression or invasion),ductal dilation,lymphadenopathy,echogenicity,echopattern,margin regularity,multifocality,internal vascularization and elastography.Subsequently,a predictive analysis was performed through univariate and multivariate logistic regression to identify predictive features for PDAC or NET diagnoses.RESULTS Our study enrolled 761 patients,predominantly male with a mean age of 68.6.PDACs were generally larger(mean 33 mm×27 mm),often had irregular margins,and displayed significant upstream ductal dilation.Hypoechogenicity was common across malignant lesions.In contrast,NETs were smaller(mean 20 mm×17 mm)and typically had regular margins with multiple lesions.Vascular involvement,although predominant in PDAC,is a common feature of all malignant neoplasms.Multifocality,however,although a rare finding,is more typical of NETs and metastases,and practically absent in the remaining lesions.Predictive analyses showed that ductal dilation and irregular margins were the most significant predictors for PDAC[odds ratio(OR)=5.75 and 3.83],with hypoechogenicity,heterogeneous echopattern and lymphadenopathies also highly significant(OR=3.51,2.56 and 1.99).These features were inversely associated with NETs,with regular margins and absence of ductal involvement or lymphadenopathies(OR=0.24,0.86 and 0.45 respectively),as already shown by the descriptive analysis.Finally,age,despite achieving statistical significance,lacks clinical value given an OR trending towards 1.CONCLUSION This study provides a comprehensive overview of EUS features for solid pancreatic lesions,identifying distinct features like upstream ductal dilation and irregular margins for PDAC vs regular margins for NETs as strong diagnostic predictors.These findings enhance the understanding of pancreatic pathologies,offering valuable insights for improved differential diagnosis and clinical management,especially in complex cases.Further prospective studies could build on these results.
基金Supported by National Natural Science Foundation of China,No.82272634 and No.62233016.
文摘BACKGROUND Pancreatic surgery has markedly evolved during the past several years with the development of minimally invasive techniques such as laparoscopy.pancreaticojejunostomy(PJ),also known as pancreatoenterostomy,is a critical step in surgical reconstruction after pancreatic resection.However,the laparoscopic performance of PJ presents additional technical challenges,especially in achieving a secure anastomosis while preserving the integrity of pancreatic tissue.AIM To evaluate the effectiveness and safety of binding and interlocking PJ(BIPJ)as a novel technique in laparoscopic pancreatic surgery.METHODS Data of patients who underwent laparoscopic pancreatic surgery from 2018 to 2023 were obtained from the hepatobiliary and pancreatic surgery database of the Second Affiliated Hospital of Zhejiang University School of Medicine and retrospectively analyzed.According to the different PJ methods used during surgery,the patients were divided into two groups:The BIPJ group and the ductto-mucosa PJ(DMPJ)group.RESULTS BIPJ was performed in 33 patients,and DMPJ was performed in 34 patients.The operative time was significantly shorter in the BIPJ group(median,340 minutes;interquartile range,310-350)than in the DMPJ group(median,388 minutes;interquartile range,341-464)(P=0.004).No significant differences were found between the DMPJ and BIPJ groups in terms of the rates of pancreatic fistula,intra-abdominal hemorrhage,intra-abdominal abscess,postoperative biliary fistula,reoperation,or postoperative hospital stay.CONCLUSION The suitability of laparoscopic PJ for all pancreatic textures,ability to perform full laparoscopy,shorter operation time,and comparable safety with traditional PJ make BIPJ a promising option for both surgeons and patients.
文摘High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and itdoes not exhibit mass lesions. It is suspected based on changes in the mainpancreatic duct in magnetic resonance cholangiopancreatography. Sometimesonly an unclear duct shows in magnetic resonance cholangiopancreatographywith no focal strictures and upstream dilatation of the main pancreatic duct. Serialpancreatic juice cytology is valuable in diagnosis of those patients.
文摘General information Hepatobiliary&Pancreatic Diseases International is a journal published bimonthly in the English language by the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou,China.We welcome original research articles,review articles,editorials,and others from any part of the world.Manuscripts are reviewed by members of the international editorial board and our expert peer reviewers,then either accepted for publication or rejected by the chief editor.Manuscripts should.
基金supported by Porsolt SAS,https://www.porsolt.com/.
文摘Objectives:The five-year survival rate for pancreatic cancer is notably low,posing a significant challenge to patient health.The primary treatments are radiotherapy and chemotherapy,sometimes combined with targeted therapy;however,their clinical benefits are limited.Therefore,developing new models to evaluate the therapeutic potential of novel molecules is essential.Fingolimod and Dimethyl Fumarate(DMF),currently used to treat multiple sclerosis,have recently been shown to have anti-cancer effects in several preclinical tumor models.This study aims to evaluate the therapeutic potential of Fingolimod and DMF in pancreatic cancer by investigating their respective in vitro cytotoxicity and in vivo antitumor effects.Methods:In this study,we evaluated for the first time these two drugs in pancreatic preclinical models in vitro using 3D spheroid tumor models and in vivo,which are compared to two standard-of-care consisting of Gemcitabine and Erlotinib.Results:In vitro,both Fingolimod and DMF induced cytotoxicity in spheroids from two pancreatic cell lines.Additionally,Fingolimod and DMF displayed anticancer effects in two subcutaneous xenograft models using PANC-1 and CFPAC-1 cells.Conclusions:Although the responses observed with Fingolimod and DMF were similar to those of Gemcitabine and Erlotinib,these findings indicate a potential emerging interest in Fingolimod and DMF for the treatment of pancreatic cancer.However,further work is still necessary to fully characterize how these drugs affect tumor progression.
基金supported by Shanghai Municipal Science and Technology Major Projectthe Strategic Priority Research Program of the Chinese Academy of Sciences(No.XDA12020373)+2 种基金the New Drug Creation and Manufacturing Program(No.2019ZX09735001)the Ministry of Science and Technology,the People's Republic of China and National Natural Science Foundation of China(No.81903762)the Key Laboratory for Chemistry and Molecular Engineering of Medicinal Resources(Guangxi Normal University,No.CMEMR2016-B02)。
文摘Pancreatic cancer,specifically pancreatic ductal adenocarcinoma(PDAC),ranks among the most prevalent malignancies and is a leading cause of cancer-related mortality worldwide.Therefore,there is an urgent need to identify novel anti-pancreatic cancer agents.This study reports a newly identified homogeneous polysaccharide,designated ESPPW,isolated from Arthrospira platensis(A.platensis).The molecular weight of ESPPW is estimated at 356 kDa,and it consists predominantly of glucose and rhamnose,with minor amounts of mannose,glucuronic acid,galacturonic acid,galactose,xylose,arabinose,and fucose.ESPPW inhibits the proliferation and migration of PDAC cells both in vitro and in vivo.Mechanistic investigations reveal that ESPPW induces apoptosis through activation of caspase-3 and is associated with upregulation of the tumor-suppressor protein p53.Notably,treatment with 2.8 nmol·L^(-1) of ESPPW leads to significant time-dependent downregulation of galectin-3(Gal-3)and glypican-6(GPC-6).These findings are corroborated by immunohistochemical analysis of tumor xenograft tissues.Furthermore,overexpression of Gal-3 and GPC-6 reverses the pro-apoptotic effect of ESPPW,as indicated by restored cycle regulatory proteins(CDK2)expression.In conclusion,these data demonstrate that ESPPW suppresses PDAC cell growth by promoting apoptosis and disrupting the functional activity of Gal-3 and GPC-6.
文摘Radiofrequency ablation(RFA),particularly endoscopic ultrasound-guided RFA(EUS-RFA),has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer,especially in patients with locally advanced or unresectable disease.This review outlines recent technological developments in EUS-RFA,including innovations in energy delivery systems,probe design,and real-time thermal monitoring,which have improved the precision and safety of the procedure.Clinical studies combining EUS-RFA with chemotherapy have demonstrated encouraging outcomes,with improvements in overall survival,progression-free survival,tumor necrosis,and symptom control compared to chemotherapy alone.Additionally,RFA-induced tumor antigen release and modulation of the tumor microenvironment suggest a potential synergistic role with immunotherapy.Despite its promise,the widespread adoption of EUS-RFA is limited by a lack of large-scale randomized controlled trials and standardized treatment protocols.
基金supported by the Yunnan Province Liu Liang Expert Workstation(No.202305AF150148)Famous Doctor Projects of Yunnan Province(No.XDYC-MY-2022-0032)+1 种基金Yunnan Health Training Project of High Level Talents(No.L-2024029)Innovation Team Special Program of Yunnan(No.202505AS350004).
文摘Objectives:Pancreatic cancer(PC)is characterized by poor prognosis due to its limited treatment choices and delayed detection.S100A14 has been implicated in tumor progression,yet its regulatory hierarchy and functional interplay in PC remain unclear.This study aimed to define the role of S100A14 in PC progression.Methods:Integrated bioinformatic analyses of TCGA-PAAD and GSE22780 datasets identified candidate hub genes.Prognostic relevance was assessed via Kaplan-Meier and ROC analyses.Functional experiments were performed in PANC-1 and BxPC-3 cells,including qRT-PCR,CCK-8 assay,Western blotting,Transwell assay,and apoptosis assay.Co-immunoprecipitation(Co-IP)was used to verify S100A14-S100A16 interaction.CHX chase and dual-luciferase assays were employed to assess protein stability and transcriptional activity.Results:S100A14 was markedly upregulated in PC tissues and cell lines and identified as a key prognostic gene.Silencing S100A14 suppressed EMT,proliferation,invasion,and migration,while reversing S100A16-mediated p53 inhibition and enhancing apoptosis.Mechanistically,Co-IP assay confirmed the protein interaction between S100A14 and S100A16;S100A14 stabilized S100A16 protein through post-translational modification without transcriptional regulation;the S100A14/S100A16 axis reduced p53 protein stability and inhibited its transcriptional activity as well as the downstream p21 expression.Critically,knockdown of S100A14 abrogated the pro-metastatic phenotype of cancer cells.Conclusion:This study identifies S100A14 promotes PC progression by stabilizing S100A16 and suppressing the tumor-suppressive p53/p21 pathway;knockdown of S100A14 can reverse the above effects,restore p53 function,and enhance cancer cell apoptosis.Targeting the S100A14/S100A16/p53 regulatory axis could represent a promising therapeutic approach for PC.
基金supported by grants from the National Natu-ral Science Foundation of China(81302161 and 82003103)the Science and Technology Department of Sichuan Province(2021YFS0375 and 2020YJ0450).
文摘A pancreas surgeon’s constant goal is to do"less damage,more radical".Currently,a small number of highly trained surgeons opt for single-incision laparoscopic pancreaticoduodenectomy(SILPD)or single-incision plus one-port LPD(SILPD+1)to minimize post-operative pain,improve convalescence,and provide a more pleas-ing cosmetic outcome[1,2].Additionally,some skilled surgeons have claimed that laparoscopic duodenum-preserving complete pancreatic head resections(LDPPHR)result in less trauma and en-hanced quality of life[3,4].However,LDPPHR is still challenging because of its lengthy learning curve and"sword-fighting"impact.Additionally,there has not been any global reporting on the suit-ability of single-incision plus one-port DPPHR with pancreaticogas-trostomy(SILDPPHR-T+1)in place of SILPD+1.This study aimed to illustrate the SILDPPHR-T+1 procedure specifics for a patient with pancreatic head intraductal papillary mucinous neoplasm(IPMN)(main pancreatic duct type)(MD-IPMN).
基金Supported by National Natural Science Foundation of China,No.82170651and the Research Support Fund of Hubei Microcirculation Society,No.HBWXH2024(1)-1.
文摘Intrapancreatic fat deposition(IPFD)has garnered increasing attention in recent years.The prevalence of IPFD is relatively high and associated with factors such as obesity,age,and sex.However,the pathophysiological mechanisms underlying IPFD remain unclear,with several potential contributing factors,including oxida-tive stress,alterations in the gut microbiota,and hormonal imbalances.IPFD was found to be highly correlated with the occurrence and prognosis of exocrine pan-creatic diseases.Although imaging techniques remain the primary diagnostic approach for IPFD,an expanding array of biomarkers and clinical scoring systems have been identified for screening purposes.Currently,effective treatments for IPFD are not available;however,existing medications,such as glucagon-like peptide-1 receptor agonists,and new therapeutic approaches explored in animal models have shown considerable potential for managing this disease.This paper reviews the pathogenesis of IPFD,its association with exocrine pancreatic disea-ses,and recent advancements in its diagnosis and treatment,emphasizing the significant clinical relevance of IPFD.
基金Supported by Department of Biotechnology,Government of India,No.RLS/BT/Re-entry/05/2012.
文摘Irreversible electroporation is a promising non-thermal ablation method that has been shown to increase overall survival in locally advanced pancreatic cancer in some studies.However,higher quality studies with proper controls and randomization are required to establish its superiority when added with neoadjuvant chemotherapy over the current management of choice,which is chemotherapy alone.Further studies are required before establishment of any survival benefit in metastatic pancreatic carcinoma,and such evidence is lacking at present.
文摘Pancreatic cancer is one of the solid tumors with the worst prognosis.Five-year survival rate is less than 10%.Surgical resection is the only potentially curative treatment,but the tumor is often diagnosed at an advanced stage of the disease and surgery could be performed in a very limited number of patients.Moreover,surgery is still associated with high post-operative morbidity,while other therapies still offer very disappointing results.This article reviews every aspect of pancreatic cancer,focusing on the elements that can improve prognosis.It was written with the aim of describing everything you need to know in 2021 in order to face this difficult challenge.
基金Supported by Research Project of the Chinese Digestive Early Cancer Physicians’Joint Growth Program,No.GTCZ-2021-AH-34-0012.
文摘BACKGROUND The treatment strategy for pancreatic pseudocysts(PPC)is comprehensive and warrants multidisciplinary participation.However,at present,the treatment concepts for PPC are inconsistent.Moreover,the timing of interventional therapy is unclear,and complication management is insufficient.Therefore,the deve-lopment of a multidisciplinary expert consensus on PPC is warranted.At present,endoscopic treatment is recommended for managing PPC in American Society for Gastrointestinal Endoscopy guideline and Chinese Consensus guidelines.CASE SUMMARY In this study,we present a rare case of PPC identified by endoscopy and imaging examination,and successfully managed by endoscopic and percutaneous dra-inage.In detail,an obese patient with a history of recurrent pancreatitis presents an irregular,elliptical cystic low-density shadow in the pancreatic region.En-doscopic ultrasound combined with double knife incision technique was used to endoscopic drainage,resulting in a favorable prognosis.CONCLUSION Ultrasound-guided endoscopic drainage for the management of PPC may provide additional insights to current clinical guidelines.
基金Supported by the National Key Research and Development Program of China,‘Clinical Performance Verification of Radial Ultrasound Endoscope’,No.2017YFC0109804the National High Level Hospital Clinical Research Funding,No.2022-PUMCH-A-076.
文摘BACKGROUND As a heterogeneous group of lesions,pancreatic cystic lesions(PCLs)vary enormously in malignant potential,mandating different treatment strategies.Despite significant advances in diagnostic imaging and laboratory tests,the accurate diagnosis of PCLs remains challenging,leading to overtreatment or delayed/missed surgical timing in patients with PCLs.CASE SUMMARY We present a case of a 64-year-old female patient in whom an asymptomatic,incidental cystic mass was found in the pancreatic tail on a routine abdominal ultrasound.After a comprehensive work-up with laboratory examinations,contrast-enhanced computed tomography,magnetic resonance imaging,and magnetic resonance cholangiopancreatography,a pancreatic pseudocyst was suspected.Subsequent endoscopic ultrasound with fine-needle aspiration and needle-based confocal laser endomicroscopy supported a benign diagnosis.Follow-up computed tomography and magnetic resonance imaging examinations five months later showed significant cyst shrinkage without any abnormalities.However,three years after being lost to follow-up,the patient was readmitted and diagnosed with pancreatic adenocarcinoma with multiple metastases,suggesting that the initial lesion was a mucinous cystic neoplasm misdiagnosed as a pan-creatic pseudocyst.CONCLUSION Comprehensive integration of all available information(e.g.,cyst features,abnormal imaging findings,cyst biochemistry,clinical history,and patient demographics)rather than over-reliance on imaging or endoscopic findings is pivotal to diagnosing PCLs,and patients with concerning features should undergo strict surveillance.
文摘Pancreatic carcinoma is one of the most lethal malignancies and has a dismal prognosis.However,advances in diagnostic modalities and better multidisciplinary management have contributed to improved survival in these patients.Of late,various recurrence patterns have been observed;the most common of them being distant metastasis followed by the pancreatic bed and lymph node recurrence.Recurrence in the remnant pancreas is on the rise due to improved survival in patients who previously underwent surgery for pancreatic cancer.Total remnant pancreatectomy is an appealing option in resectable remnant pancreatic carcinoma without distant metastasis.It is an entity showing an increasing incidence and demanding further in-depth studies to elucidate the exact pathological mechanism and to establish appropriate management protocols.
文摘BACKGROUND Pancreatic fluid leakage is a rare complication of pancreatic cancer and often requires drainage when conservative therapy fails.Endoscopic,percutaneous,and surgical drainage are options.Minimally invasive endoscopic procedures are generally considered the first-line treatment,with either a transpapillary approach or an endoscopic ultrasound-guided transmural approach selected depending on the case.Various dilators are used to dilate tracts to the leakage site.However,reports of dilation through a rigid trans-tumoral tract using a drill dilator remain extremely rare.CASE SUMMARY A 74-year-old woman with pancreatic body and tail cancer developed fever and left-sided chest pain after multiple courses of chemotherapy.Computed tomography revealed fluid accumulation around the pancreatic tail and spleen along with a left pleural effusion.The effusion was diagnosed as reactive secondary to pancreatic fluid leakage.Endoscopic retrograde cholangiopancreatography identified irregular stenosis of the main pancreatic duct in the pancreatic body.Distal to the stenosis,the main ductal structure was nearly obliterated by the tumor.The contrast medium had leaked into the pancreatic fluid leakage area through several fine,disrupted ductal structures.The guidewire was successfully advanced through an extremely fine tract that was not the main contrast-filling route.Standard dilators failed to expand the rigid trans-tumoral tract.A second endoscopic retrograde cholangiopancreatography using a drill dilator successfully expanded the trans-tumoral tract,enabling endoscopic nasopancreatic drainage tube placement.Subsequently,the pancreatic fluid leakage and pleural effusion resolved.CONCLUSION Even in rigid trans-tumoral tracts,the use of a drill dilator can facilitate successful tract expansion,enabling effective drainage.
