Efficacy and safety of S-1 based adjuvant chemoradiotherapy for resected pancreatic ductal adenocarcinoma with high-risk pathological feature: a prospective, single-arm, interventional study

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.

Digestive tract reconstruction in pancreaticoduodenectomy in University Hospitals of China: a national questionnaire survey

Background Pancreaticoduodenectomy(PD)has been widely applied in general hospitals in China;however,there is still a lack of unified standards for each surgical technique and procedure.This survey is intended to investigate the current status of digestive tract reconstruction after PD in university hospitals in China.Method A cross-sectional survey was conducted among the members of the Young Elite Pancreatic Surgery Club of China by using the Questionnaire for Digestive Tract Reconstruction after Pancreaticoduodenectomy.The questionnaire was disseminated and collected by point-to-point communication via WeChat public platforms.Results A total of 73 valid questionnaires were returned from 65 university hospitals in 28 provincial divisions of China's Mainland.The respondents who performed PD surgery with an annual volume of over 100 cases accounted for 63%.Generally,laparoscopic PD was performed less often than open PD.Child and Whipple reconstructions accounted for 70%and 26%,respectively.The sequence of pancreatoenteric,biliary-enteric,and gastrointestinal reconstruction accounted for 84%of cases.In pancreatoenteric anastomosis,double-layer anastomosis is the most commonly employed type,accounting for approximately 67%,while single-layer anastomosis accounts for 30%.Of the double-layer anastomoses,duct-to-mucosa/dunking(94%/4%)PJ was performed with duct-mucosa using the Blumgart method(39%)and Cattel-Warren(29%),with continuous/interrupted sutures in the inner layer(69%/31%)and continuous/interrupted sutures in the outer layer(53%/23%).In single-layer anastomosis,continuous/interrupted sutures accounted for 41%/45%.In hepatojejunostomy,single-layer/double-layer suture accounted for 79%/4%,and continuous/interrupted suture accounted for 75%/9%.Forty-six percent of the responding units had not applied double-layer biliary-intestinal anastomosis in the last 3 years,75%of the responding surgeons chose the anastomosis method according to bile duct diameter,with absorbable/non-absorbable suture accounting for 86%/12%.PD/pylorus-preserving PD accounted for 79%/11%of GJ cases,the distance between GJ and HJ<30 cm,30-50 cm and>50 cm were 11%,75%,and 14%,respectively.Antecolic/retrocolic GJ accounted for 71%/23%of cases.Twenty-two percent of GJ cases employed Braun anastomosis,while 55%and 19%of GJ cases used linear cutting staplers/tube-type staplers,respectively;60%/14%were reinforced/not reinforced via manual suturing after stapler anastomosis.Manual anastomosis in GJ surgery employed absorbable/non-absorbable sutures(91%/9%).Significant differences in reconstruction techniques were detected between different volumes of PD procedures(<100/year and>100/year),regions with different economic development levels,and between north and south China.Conclusion Digestive tract reconstruction following PD exists heterogeneity in Chinese university hospitals.Corresponding prospective clinical studies are needed to determine the consensus on pancreatic surgery that meets the clinical reality in China.

Heparin-induced thrombocytopenia thrombosis after pancreaticoduodenectomy without definitive prophylactic or therapeutic use of heparin:a case report

Heparin-induced thrombocytopenia thrombosis(HITT)is a rare and potentially life-threatening complication after abdominal surgery,and it always occurs after the prophylactic or therapeutic use of heparin.HITT after pancreaticoduodenectomy(PD)has not been reported before.Herein,we reported a case of HITT after PD without prophylactic or therapeutic use of heparin.A 74-year-old female patient who suffered resectable pancreatic head cancer was transferred to our center for surgery.An open PD procedure was performed,and the operation was smooth.No heparin was used after surgery.Nine days after surgery,the platelet sharply declined to 48×10^(9)/L(100-350),and the D-dimer soared up to 33.56 mg/L(0-0.55).Ultrasound examination showed vein thrombosis in both the lower limb and the right upper limb.HIT-antibody was 6.3 U/mL(0-0.6).The diagnosis of HITT was confirmed.Fondaparinux was used.On postoperative day(POD)23,the platelet recovered to the normal range.On POD 27,she was discharged without thromboembolism or active bleeding,and oral rivaroxaban was prescribed.One month after discharge,the platelet remained normal,and she did not complain of discomfort.

Efficacy and toxicity comparison of nab-paclitaxel plus S-1 and nab-paclitaxel plus gemcitabine as first-line chemotherapy for metastatic pancreatic cancer

To compare efficacy and safety of nab-paclitaxel plus gemcitabine(AG)with nab-paclitaxel plus S-1(AS)as first-line treatment for metastatic pancreatic cancer,we conducted a retrospective analysis by reviewing medical records of 53 metastatic pancreatic cancer patients in our institution.They received either AG(nab-paclitaxel 125 mg/m 2 on days 1,8 and gemcitabine 1000 mg/m 2 on days 1,8)or AS(nab-paclitaxel 125 mg/m 2 on days 1,8 and S-180-120 mg on days 1-14)chemotherapy.We found that AS had higher objective response rate(36%vs 21.4%),better disease control rate(84%vs 75%),prolonged time to progression(TTP,7.1 vs 5 months),and improved overall survival(OS,15.3 vs 12 months)when compared with AG.In Cox proportional hazards model,sex was significantly associated with TTP(P value=.031)and metastatic sites plus treatment after progression were significantly associated with OS(P value=.028 and.01,respectively).The incidence rate of chemotherapy-related adverse events was similar in both groups.Neutropenia(50%and 60%,all grade;21.4%and 36%,grade 3 or 4,in AG and AS group)and sensory neuropathy(21.4%and 24%,all grade;3.6%and 4%,grade 3 or 4,in AG and AS group)were the most common hematologic and non-hematologic toxicity.Thus,we believed that AS is a reasonable and convenient alternative for patients treated with AG as first-line chemotherapy for metastatic pancreatic cancer.

Characteristics and outcomes of patients with autoimmune pancreatitis after pancreatectomy:a retrospective study

Objective:Autoimmune pancreatitis(AIP)is a rare and special type of pancreatitis,which is often difficult to distinguish from pancreatic cancer.We aimed to discuss the clinical characteristics,operation characteristics,and therapeutic effects of AIP pa-tients who received surgical treatment based on retrospective analysis.Methods:The medical records of patients who underwent surgery at Peking Union Medical College Hospital from January 2012 to July 2021 and whose postoperative pathology was AIP were collected.Clinical symptoms,laboratory examinations,imaging features,surgical information,and prognostic data were analyzed.Results:Nineteen patients with AIP(median age 60 years old,14 males)underwent surgery,whose main indication for surgery was suspected of a malignant lesion(n=18,94.7%).Ten patients underwent pancreaticoduodenectomy,8 underwent distal pancreatectomy,and 1 underwent total pancreatectomy,the pathological result of whom were all AIP.The main postoperative complication was pancreatic fistula(n=11,57.9%),and one patient(5.3%)underwent a second operation due to gastrointestinal anastomotic bleeding.One patient(5.6%)had a recurrence of AIP,3 patients(16.7%)were treated with glucocorticoid after sur-gery,and one patient(5.6%)was treated with immunosuppressors.Conclusions:Differential diagnosis of AIP from pancreatic cancer is complex.Operation difficulty and complication incidence for patients with AIP were similar to pancreatic cancer patients.Although glucocorticoid is the first-line treatment for AIP,surgery may still be necessary for patients who are strongly suspected of a malignant lesion.

Early drain removal after major pancreatectomy reduces postoperative complications:a single-center,randomized,controlled trial

Objectives:Timing of drain removal and its effects on complications after major pancreatectomy remain controversial.We designed this study to assess whether early drain removal after major pancreatectomy influences the incidence of complications in the patients with low risk of postoperative pancreatic fistula(POPF).Methods:This is a single-center randomized controlled trial(RCT).A total of 144 patients undergoing pancreaticoduodenectomy(PD)and distal pancreatectomy(DP)who met the criteria,including drain amylase on postoperative day(POD)1 and 3 less than 5000 U/L and drain output within POD 3 less than 300 mL/d,were randomly assigned to early drain removal(POD 3)or standard drain removal(≥POD 5).The primary outcome was major complications(Clavien-Dindo grades 2-4),and the secondary outcome was POPF,reintervention treatment,readmission,and total medical expense within 3 months after surgery.Results:A total of 5 patients in early drain removal group had at least 1 major complications(grades 2-4),compared to 15 patients in standard drain removal group(P=.028).The incidence of grade B/C pancreatic fistula was not significantly different(2.8%vs 0%).Multivariate analysis demonstrated that early drain removal was an independent factor associated with a reduced risk of major complications(P=.039,odds ratio=0.314).Majority of major complications occurred in PD patients,and only very few cases occurred in DP patients.Stratified analysis showed that early drain removal significantly reduced the major complications only in the patients undergoing PD.Conclusion:This single-center RCT shows early drain removal on POD 3 is safe for both DP and PD patients,under our criteria.Early drain removal could reduce the incidence of major complications in patients undergoing PD.

Real-world study of surgical treatment of pancreatic cancer in China: annual report of China Pancreas Data Center (2016-2020)

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.

Acute necrotizing pancreatitis: challenges and interventions-a narrative review

Acute pancreatitis(AP)is a complicated disease with rising incidence over the years.20%of AP will develop into acute necrotizing pancreatitis(ANP).Interventions for ANP have evolved from traditional open surgery to minimally invasive step-up approaches.Infected pancreatic necrosis(IPN)is the most serious event of ANP and associated with extremely poor prognosis.The CT-based classification of IPN describes various types of IPN and will help to carry out surgical interventions for each subtype.Nevertheless,many challenges are still remaining during the treatment of ANP.Including the balance between endoscopic and surgical approaches,and the selection of optimal timing of surgical intervention for infected necrosis.In nowadays treatment scenario of ANP,the necessity for open surgery remains to be debated.Despite of the development of advanced interventional techniques,postoperative residual infection(PRI)remains thorny,and effective prevention and treatment of PRI is of significance.

Roles of FGF21 and irisin in obesity-related diabetes and pancreatic diseases

In the past decades,skeletal muscle has become the focus of numerous studies due to its potential physiological role as an endocrine organ secreting hundreds of myokines.Among these myokines,fibroblast growth factor 21(FGF21)and irisin are novel hormone polypeptides sending signals to regulate the function of specific organs,like skeletal muscle,liver,pancreas,and adipose tissue.Both hormones have been reported to normalize glucose,improve insulin resistance,and promote lipid homeostasis,thereby preventing the development of metabolic disorders,such as obesity and diabetes.Besides preserving pancreaticβ-cell functions,FGF21 also protects pancreatic acini from inflammation and reduces proteotoxic stress via facilitating digestive enzyme secretion.Meanwhile,irisin is found to inhibit the pancreatic cancer cell growth as well.This review attempts to focus on the current knowledge of FGF21 and irisin and their effective roles in pancreas including pancreaticβ-and acinar cells under various physiological conditions,its anti-diabetic actions,and the clinical implications.

Pancreatic cystic neoplasms:current and future approaches to identify patients at risk

Pancreatic cystic neoplasms(PCNs)are a group of entities with distinct risks and various treatments.Identification of the PCN patients at risk is thus critical.A correct diagnosis is the key to select high-risk patients.However,the misdiagnosis rate is extremely high even computer tomography,magnetic resonance imaging,and endoscopic ultrasonography were applied.Current approaches for differential diagnosis and identifying high-risk patients in certain types of PCNs are not powerful enough to make a clinical acceptable accuracy of diagnosis.The approaches mainly rely on imaging and tumor marker test.We here summarized the current approaches,and reviewed novel approaches under development.For instance,cyst fluid test of glucose or vascular endothelial growth factor A shows the best performance in identifying mucinous cystic neoplasms or serous cystic neoplasms.Multidisciplinary team(MDT)discussion is another way to improve the accuracy of diagnosis.Combination of MDT with validated novel approaches with high sensitivity and specificity is the best way to select truly high-risk patients with PCNs.

Pancreatic biomarkers:role in diabetes mellitus

Diabetes mellitus refers to a group of diseases that cause high blood sugar levels.The most common type is type 2 diabetes,which is caused by insulin resistance and inadequate insulin production.However,diabetes can also result from conditions affecting the exocrine pancreas.Both type 1 and type 2 diabetes patients may experience changes in their pancreatic exocrine function,leading to reduced levels of fecal elastase-1 in many cases.This review article focuses on the role of specific pancreatic biomarkers in diabetes mellitus,including cholecystokinin,trypsin,chymotrypsin,carboxypeptidase,amylase,lipase,secretin,elastase-1,and retinol-binding protein 4 about recent advances and discoveries,significant gaps in the literature,current debates,and potential directions for future research related to these biomarkers about diabetes mellitus.This review article discusses various biomarkers related to pancreatic exocrine and endocrine function and their implications in diabetes.It suggests that gut cholecystokinin may play a role in lowering glucose synthesis through a neural network and resistance to it could contribute to hyperglycemia in diabetic patients.It also discusses the use of various markers such as serum trypsin concentration,amylase and lipase levels,pancreatic elastase levels,and fasting secretin levels to assess pancreatic exocrine function.Additionally,the article explores the role of carboxypeptidase E in the endocrine and neurological systems and its association with disorders.Moreover,it also highlights the involvement of retinol-binding protein 4 in the development of type 2 diabetes and insulin resistance.

Pharmacological and non-pharmacological prophylaxis in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis:a narrative review

Endoscopic retrograde cholangiopancreatography is a diagnostic and therapeutic procedure for various gastrointestinal prob-lems.Pancreatitis is a severe complication of the procedure.The main objective of this study was to address if post-endoscop-ic retrograde cholangiopancreatography(ERCP)pancreatitis can be prevented and what are the various pharmacological and non-pharmacological options along with their efficacy.Keywords“post-ERCP”and“pancreatitis”were used to search articles in Pubmed.Randomized controlled trials on patients undergoing ERCP due to any disease using pharmacological or non-pharma-cological intervention published in the last 7 years were included.Observational studies,descriptive studies,reviews,and studies with no full access were excluded.The primary outcome in the trials was a frequency of post-ERCP pancreatitis.Non-steroidal anti-inflammatory drugs(NSAIDs)were the most effective drugs in reducing the incidence of pancreatitis.The preferred route was rectal.After NSAIDs,intravenous hydration and sublingual nitrate showed promising outcomes,especially when combined with rectal NSAIDs.Other drugs like magnesium sulfate and nafamostat mesilate did reduce the incidence,but the results were not statistically significant.Epinephrine spray on duodenal papilla showed no benefits and instead had a risk of increasing the incidence.Stent placement also reduced the incidence of pancreatitis.In conclusion,rectal NSAIDs alone or combined with IV hydration and sublingual nitrate significantly reduced the incidence of pancreatitis,and stent placement was comparable to pharmacological interventions.Thus,regular use of pharmacological interventions before the procedure can help to reduce the incidence of this grave complication.

Pancreatic adenocarcinoma and aging:understanding the menace for better management

Pancreatic ductal adenocarcinoma(PDAC)is the leading cause of cancer-related death worldwide.As PDAC is more common in older adults and the population is aging,the incidence of pancreatic adenocarcinoma is expected to increase in the coming years.As a result,the mechanism and clinical management of PDAC in the elderly population is receiving more attention.This review will discuss age-related morphological and pathological changes,clinical management,surgery and adjuvant therapies,and molecular changes in elderly PDAC patients.More research is needed to clarify molecular mechanisms and develop new prevention and treatment strategies for PDAC in elderly patients.

Perspective of molecular imaging and peptide receptor radionuclide therapy in pancreatic neuroendocrine tumors:where do we stand?

The clinical use of nuclear medicine imaging and therapy in pancreatic neuroendocrine tumors has been greatly strengthened since the approval of ^(68)Ga-DOTATATE and ^(177)Lu-DOTATATE.However,many aspects are still under discussion.In this 2-part article,we aim to collect and discuss current evidence of molecular imaging and peptide receptor radionuclide therapy(PRRT)in pancreatic neuroendocrine tumor.In the first part,we will address some critical aspects of ^(68)Ga-SSAs imaging,including diagnostic efficacy,recurrence detection and follow-up,patient selection for PRRT,and pitfalls in image interpretation.Besides,we will also briefly discuss the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography,special imaging strategy in regard to insulinoma,and the status of radiolabeled somatostatin receptor antagonist.In the second part,we aim to review the current evidence of PRRT in pancreatic neuroendocrine tumor,focusing on efficacy and safety in particular.We will also introduce the recent development of PRRT,including PRRT in high-grade neuroendocrine neoplasms,retreatment PRRT,upfront PRRT,PRRT in the setting of neoadjuvant therapy and conversion therapy,combination therapies with PRRT,PRRT withαradionuclides,and PRRT with antagonists.

Gut microbiome:the third musketeer in the cancer-immune system cross-talk

The fascinating hypothesis that microbes lead to cancer has long been dwelled upon but has only been recently investigated in cancers other than those of stomach and colon.Microbes can affect cancer cells directly through toxins or metabolites.They also play a significant role in the development and maturation of the immune system and can indirectly affect cancer cells through the immune system.Reliable mouse models and affordable sequencing technologies,have made it possible in current times,to delineate the role of microbes in undermining cancer immune surveillance and indirectly promoting oncogenesis.In this review,we explore the cancer-gut microbiome-immune trialogue,focusing on pancreatic cancer.We review how gut-microbiome interacts with immune system to promote oncogenesis and how modulation of gut-microbiome can be used as an effective therapeutic strategy to reprogram the immune system for augmenting anti-tumor response and enhance immunotherapy efficacy in traditionally resistant pancreatic cancer.

The current surgical treatment of pancreatic cancer in China: a national wide cross-sectional study

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.

Pancreatic steatosis and its correlation with clinicopathological features in patients with pancreatic neuroendocrine neoplasms

Background and objective:The incidence of pancreatic neuroendocrine neoplasms(pNENs)has been increasing year by year,and pancreatic steatosis has been paid more and more attention to by clinicians.Our study aims to reveal the correlation between pancreatic steatosis,clinicopathological parameters,and the prognosis of patients with pNENs.Methods:The clinicopathological data of patients with pNENs who underwent surgical resections in our institution from January 2013 to May 2022 were retrospectively analyzed.The mean computed tomography(CT)values of the pancreas and spleen were used to assess the severity of the pancreatic steatosis.Pearson Chi-square test,T test,Mann Whitney U test,Univariate Cox re-gression,and Multivariate Cox regression were used to explore the relationship between pancreatic steatosis and age,sex,body mass index,tumor type,tumor location,tumor stage,blood lipid,prognosis,and other factors.Results:A total of 122 patients were included in our study,and 19.67%have pancreatic steatosis.The incidence of pancreatic steatosis was significantly higher in patients with fatty liver than in patients without fatty liver(36.8%vs 16.5%,P=.04).In insu-linoma,the incidence of pancreatic steatosis in elderly patients was significantly higher than in young and middle-aged patients(41.7%vs 9.3%,P=.025).There was no significant difference in lipid levels between the pancreatic steatosis group and the non-pancreatic steatosis group(P>.05).Kaplan-Meier curves show that the prognosis of stage III/IV patients was significantly worse than that of stage I/II patients(P<.001).However,there was no significant difference in prognosis between patients with and without pancreatic steatosis(P=.404).Conclusion:The incidence of pancreatic steatosis was significantly higher in those with fatty liver than those without fatty liver.There is a high incidence of pancreatic steatosis in elderly patients with insulinoma.American Joint Committee on Cancer(AJCC)stage,but not pancreatic steatosis,significantly affected the prognosis of patients with pNENs.

Advances in the treatment of gastroenteropancreatic neuroendocrine neoplasms with somatostatin analogs

Neuroendocrine neoplasms (NENs) include well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinomas (NECs). Somatostatin receptors (SSTRs) are highly expressed on NETs cells, and somatostatin analogs (SSAs) could bind to SSTRs with high affinities, regulating cell proliferation and hormone secretion. As many clinical trials have demonstrated the antiproliferative efficacy and safety of SSAs in metastatic gastroenteropancreatic NETs (GEP-NETs), SSAs have been recommended by multiple NEN guidelines as the first-line therapy of GEP-NETs. In recent years, more and more researches have been exploring new therapeutic possibilities of SSA in GEP-NETs, such as high-dose SSA as second-line therapy, SSA in metastatic GEP-NETs with Ki-67 > 10%, SSA as adjuvant therapy for postoperative pancreatic NETs patients, and combinations of SSA with chemotherapy or targeted therapy. In this review, we summarized the latest published or released researches and discussed new application attempts of SSA in GEP-NETs.

Isolated myeloid sarcoma of the pancreas:a case report

Myeloid sarcoma(MS)is a rare solid tumor,and the diagnose is ambiguity.On account of the rarity of MS,it is often misdiagnosed.In order to promote clinicians to have a better understanding of the disease,a case of isolated myeloid sarcoma of the pancreas has been admitted by the Center for Pancreas,the First Affiliated Hospital of Nanjing Medical University.A 36-year-old male patient presented to our department with recurrent postprandial abdominal distension and pain,and weight loss.The initial radiologic diagnose of the lesion was pancreatic cancer and a pancreatectomy was performed.Eventually,the histopathology result confirmed the final diagnosis:myeloid sarcoma(MS).To date,this type of disease has hardly been reported in the literature.This case report describes the diagnostic and treatment process and discusses the better way for diagnosis,which will guide such diseases in the future.

Current situation,consensus and controversy of perioperative nutrition management in pancreatic surgery:A narrative review

Pancreatic surgery contains several major procedures of pancreatectomy.Surgical trauma,severe complications and preoperative nutritional disorders will affect postoperative recovery and clinical outcomes of patients.Perioperative whole-course nutrition management focus on rational nutritional care from admission to discharge even post-hospital follow-up,including preoperative nutritional screening,perioperative nutrition assessment and intervention.The whole-course strategy has been validated in some other fields by RCTs and is also seemed to be suitable for pancreatic surgery.However,few high-grade evidences have been published and controversy still exists.This review aims to reflect the current situation,consensus and controversy of perioperative nutrition management in pancreatic surgery,expecting to provide necessary guidance for clinical research and practice.