Abstract:Pancreatic cystic neoplasms account for 10% to 15% of all pancreatic cystic lesions, and their detection rates are increasingly rising with use of advanced imaging techniques and development of medical technologies. They are mostly benign or low-grade malignant tumors with the possibility of malignant transformation, and require surgical resection, and are also suitable for minimally invasive surgery. However, pancreatic surgery is still a high-risk procedure due to high complication rates, and precise early diagnosis is crucial for ensuring correct treatment. For most pancreatic cystic neoplasms, enhanced pancreatic CT or if necessary, in combination with MRCP or MRI is sufficient to achieve a correct diagnosis. Endoscopic ultrasonography plus puncture aspiration is helpful for diagnosis confirmation and determining the timing of surgery. The choice of surgical procedures mainly depends on the location and nature of the tumors.

Abstract:Pancreatic neuroendocrine neoplasms (pNENs) comprise a heterogeneous group of tumors. Medical managements that include biotherapy, molecular targeted therapy and chemotherapy are the main methods for patients with locally unresectable lesion or distant metastases. In recent years, the number of studies about the use of targeted antiangiogenic drugs for pNENs is growing, which provides new insight on the treatment options for this condition.

Abstract:In recent years, some progress has been made in the research of severe acute pancreatitis, which has obvious influence on clinical diagnosis and treatment. An evidence-based international consensus statements on the management of severe acute pancreatitis (according to the GRADE quality of evidence criteria) was developed by a collaborative expert panel in the World Congress of Emergency Surgery held in 2018 in Bertinoro, Italy, and was published in the World Journal of Emergency Surgery in June 2019. The guidelines mainly comprise the following five topics: diagnosis, antibiotic treatment, management in the intensive care unit, surgical and operative management, and open abdomen. The guidelines thoroughly summarize and extract the principle of the clinical diagnosis and treatment of severe acute pancreatitis, and reflect the current status and future directions of the treatment of severe acute pancreatitis, so they are worth learning and using for reference.

Abstract:Objective: To investigate the safety and efficacy of laparoscopic distal pancreatectomy (LDP) in treatment of malignant tumors of the body and tail of the pancreas.
Methods: The clinical data of 80 patients undergoing surgical treatment for malignant tumors of the body and tail of the pancreas from January 2013 to December 2017 were retrospectively analyzed. Of the patients, 36 cases underwent LDP and 44 cases underwent open distal pancreatectomy (ODP). The main clinical variables between the two groups of patients were compared.
Results: There were no significant differences in the general data between the two groups of patients (all P>0.05). The operative time in LDP group was significantly longer than that in ODP group (P<0.05), but no significant differences were noted in other intraoperative variables (intraoperative blood loss, blood transfusion rate and number of resected lymph nodes) between the two groups (all P>0.05). The results of postoperative pathology (TNM stage, positive lymph nodes and R0 resection rate) showed no significant differences between the two groups (all P>0.05). No significant differences were observed between the two groups in terms of complications, reoperation rate and death within postoperative 30 d (all P>0.05), but LDP group was superior to ODP group with regard to the length of postoperative hospital stay, ICU admission rate, time to anal gas passage and time to ambulation (all P<0.05). There was no significant difference in the median survival time between the two groups (χ2=0.09, P=0.76).
Conclusion: LDP is safe and feasible in treatment of malignant tumors of the body and tail of the pancreas, and has the same surgical efficacy with ODP. It also has the advantages of minimally invasive surgery such as small trauma and rapid postoperative recovery.

Abstract:Objective: To investigate the feasibility, safety and clinical application value of the “3+2” mode robotic distal panceatectomy using the da Vinci surgical system. 
Methods: The clinical data of 60 patients undergoing distal pancreatectomy using the da Vinci robotic surgical system from June 2017 to December 2018 were retrospectively analyzed. Of the patients, 30 cases underwent robotic distal pancreatectomy under a the “3+2” mode (observation group), namely, 3 mechanical arms 
(2 manipulator arms and 1 camera arm) and 2 assisting surgeons, with the second assisting surgeon substituting the third arm of the robot under the classical mode; another 30 cases underwent robotic distal pancreatectomy under the classical mode (control group). The main clinical variables were compared between the two groups. 
Results: The general clinical data were comparable between the two groups. There were no significant differences in term of intraoperative blood loss, open conversion rates, blood transfusion rates, time to postoperative gas passage, length of postoperative hospital stay and incidence rates of postoperative complications as well as spleen preserving rates in patients planned for spleen preservation between the two groups (all P>0.05), but the operative time was shorter and hospitalization cost was lower in observation group than those in control group (both P<0.05).
Conclusion: Using “3+2” mode of da Vinci robot in distal pancreatectomy can improve the surgical field, enhance the collaborative operation between the assisting surgeons, reduce hospitalization costs and shorten the operative time and learning curves. Moreover, it can achieve the similar clinical efficacy with that under the classical mode. The long-term clinical efficacy of this mode still needs further verification by future studies. 

Abstract:Objective: To compare the short- and long-term efficacy of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in treatment of adenocarcinoma of the papilla of Vater. 
Methods: The clinical data of 89 patients with carcinoma of the papilla of the Vater undergoing pancreaticoduodenectomy from January 2012 to December 2017 were retrospectively analyzed. Of the patients, 50 cases underwent OPD and 39 cases underwent LPD. The main clinical variables between the two groups of patients were compared.
Results: The general data were comparable between the two groups of patients. There were no significant differences in operative time and cases requiring intraoperative blood transfusion between the two groups (both P>0.05), but the intraoperative blood loss in LPD group was significantly less than that in OPD group (P<0.05). The length of postoperative hospital stay in LPD group was significantly shorter than that in OPD group (P<0.05), but the incidence rate of each postoperative complication, re-operation rate and postoperative 30 d death rate showed no significant differences between the two groups (all P>0.05). The R0 resection rates and other postoperative pathological results showed no significant difference between the two groups (all P>0.05). There were no significant differences in 1-, 3- and 5-year overall survival rates and disease-free survival rates between the two groups (all P>0.05).
Conclusion: In treatment of adenocarcinoma of the papilla of Vater, LPD offers the same oncological radicalness as OPD, without increase of complications, and the long-term outcomes of the two procedures are also similar.

Abstract:Objective: To evaluate the feasibility, safety and surgical skills of complete laparoscopic pancreaticoduodenectomy (CLPD).    
Methods: The clinical data of 22 patients undergoing CLPD in the Department of Hepatobiliary Surgery of Shanxi Provincial People’s Hospital from January 2015 to March 2019 were retrospectively analyzed. All patients underwent CLPD by using the conventional five-hole method, and pancreaticojejunostomy by using “pancreatic duct-jejunum anastomosis plus closed-loop suture running through the cut end of the pancreas to the seromuscular layer of the jejunum”. 
Results: CLPD was completed in all the 22 patients, without any open conversion. The average operative time was (655±65.66) min, average intraoperative blood loss was (364±177.76) mL, and 12 cases received an intraoperative blood transfusion, with an average volume of (533±188.56) mL. The incidence of overall postoperative complications was 31.8% (7/22), including grade A pancreatic fistula in 2 cases (9.0%), grade B pancreatic fistula in 1 case (4.5%), bile leakage in 1 case (4.5%), intraperitoneal hemorrhage, in 1 case (4.5%), anastomotic bleeding in 1 case (4.5%) and pulmonary infection in 1 case (4.5%), respectively. Postoperative follow-up was conducted for 3 42 months, 2 patients died from tumor recurrence, and the other 20 patients were alive without recurrence or metastasis.
Conclusion: CLPD is safe and feasible and also has the advantages of less trauma and quick postoperative recovery. This procedure can be further generalized with the constant accumulation of experience.

Abstract:Objective: To analyze the expression of speedy/RINGO cell cycle regulator family member A (Spy1) in pancreatic carcinoma and its clinical significance. 
Methods: The Spy1 protein expressions in 85 surgical specimens of pancreatic cancer tissue were determined by immunohistochemical staining. The relations of Spy1 protein expression with the clinicopathologic factors and postoperative survival of the pancreatic cancer patients were analyzed, and the factors affecting the survival rates of the patients were also analyzed by statistical methods.
Results: Of the 85 specimens of pancreatic tissue, high Spy1 expression was found in 55 cases (64.7%), and low Spy1 expression was seen in 30 cases (35.3%). The expression of Spy1 protein was significantly associated with the tumor size, TNM stage and degree of differentiation (all P<0.05). The 1- and 3-year tumor-free survival rate and overall survival rate in patients with high Spy1 expression were significantly lower than those in patients with low Spy1 expression (all P<0.05). The high Spy1 expression (P=0.023) and lymph node metastasis (P=0.005) were independent risk factors for tumor-free survival rate in pancreatic cancer patients, and the high Spy1 expression (P=0.035) and TNM stage (P=0.037) were independent risk factors for overall survival rate in pancreatic cancer patients.
Conclusion: High expression of Spy1 protein is associated with malignant clinicopathologic features and poor prognosis in pancreatic cancer patients. It can be used as a prognostic indicator for pancreatic cancer patients.

Abstract:Objective: To investigate the expression of heme oxygenase-1 (HO-1) in pancreatic cancer tissue and its clinical significance.
Methods: The HO-1 expressions in specimens of pancreatic cancer tissue and tumor adjacent tissue from 80 cases of pancreatic cancer were determined by immunohistochemical staining and Western blot analysis, respectively. The relations of HO-1 with the clinicopathologic features and prognosis of pancreatic cancer patients were determined by statistical analyses.
Results: The results of immunohistochemical staining and Western blot analysis showed that both the positive expression rate and relative expression levels of HO-1 protein in pancreatic cancer tissue were significantly higher than those in tumor adjacent tissue (both P<0.05). The HO-1 expression in pancreatic cancer tissue was significantly associated with TNM stage, degree of tumor differentiation and lymph node metastasis (all P<0.05), but irrelevant to the sex and age (both P>0.05). Log-rank test showed that the median survival time of patients with HO-1 positive expression was significantly lower than that in patients with its negative expression 
(25.1 months vs. 36.7 months, P<0.05).
Conclusion: HO-1 is highly expressed in human pancreatic cancer tissue and is closely related to the malignant clinical characteristics and unfavorable prognosis of pancreatic cancer patients. It may probably become a new target for pancreatic cancer investigation and treatment.

Abstract:Objective: To investigate the expression of miR-526b in pancreatic cancer and its effects.  
Methods: The expressions of miR-526b in 52 specimens of pancreatic cancer and adjacent tissue as well as in different pancreatic cancer cell lines (BxPC-3, SW1990, PANC-1 and AsPC-1) and normal pancreatic ductal epithelial cells (HPDE6-C7) were determined by qRT-PCR. In pancreatic cancer cells after transfection with miR-526b mimics, miR-526b inhibitors and negative control sequences, the proliferation, invasion and apoptosis ability were examined by CCK-8, Transwell assay and flow cytometry, respectively. The potential target gene of miR-526b was analyzed by using biosoftware and dual-luciferase reporter assay, and then was verified by Western blot and qRT-PCR as well as correlation analysis.
Results: The expression levels of miR-526b in pancreatic cancer tissue was significantly lower than that in adjacent tissue, and in each pancreatic cell line was significantly lower than that in normal pancreatic ductal epithelial cell line (all P<0.05). The proliferative ability was significantly decreased, the apoptotic rate was significantly increased and the invasion ability was significantly weakened in pancreatic cells transfected with miR-526b-mimics (all P<0.05), while the opposite changes occurred in those transfected with miR-526b inhibitors (all P<0.05). The results of analysis showed that XRCC5 was a potential target gene for miR-526b; in pancreatic cells, both mRNA and protein expressions of XRCC5 were down-regulated after transfection with miR-526b mimics, and were upregulated after transfection with miR-526b inhibitors (all P<0.05); there was a negative correlation between miR-526b XRCC5 mRNA in pancreatic cancer tissue (r=–0.456, P<0.05).
Conclusion: The expression of miR-526b is down-regulated in pancreatic cancer, and the low expression of miR-526b can promote the proliferation and invasion and inhibit the apoptosis of pancreatic cancer cells. The mechanism may be related to the up-regulation of the expression of its target gene XRCC5.

Abstract:Objective: To investigate the inhibitory effect of shikonin on severe acute pancreatitis (SAP) and associated acute lung injury (ALI) in rats.
Methods: Twenty-four male SD rats were equally randomized into the control group, model group and treatment group. Rats in both model group and treatment group underwent SAP induction by retrograde pancreaticobiliary duct injection of 4% sodium taurocholate, while those in control group underwent a sham operation. Rats in treatment group were administered with shikonin (50 mg/kg) by gavage 2 h before model creation, while rats in the other two groups received vehicle of the same volume by the same fashion. Six hours after operation, rats in each group were sacrificed and the blood samples as well as the pancreatic and lung tissue specimens were collected. The pathological changes in pancreatic and lung tissues were observed, the lung wet/dry weight ratio, the serum levels of TNF-α IL-6, and the expression levels of PI3K, phosphorylated PI3K (p-PI3K) and NF-κB in lung tissue were determined.
Results: No abnormalities were observed in the pancreatic and lung tissues from control group, while evident pathological lesions were found in the pancreatic and lung tissues from either model group or treatment group, but the degrees of pathological changes in both pancreatic and lung tissues from treatment group were milder than those from model group. There were significant differences in the pathological scores for pancreatic and lung tissues among the groups (all P<0.05). The serum levels of TNF-α and IL-6, the lung wet/dry weight ratios, as well as the p-PI3K/PI3K and NF-κB expression levels in the lung tissues in both model group and treatment group were significantly increased compared with control group (all P<0.05), but the changing amplitudes of above variables in treatment group were smaller than those in model group (all P<0.05).
Conclusion: Shikonin has inhibitory effect against both SAP and associated ALI in rats. The mechanism may be related to its reducing the release of inflammatory factors and suppressing the activation of PI3K-Akt-NF-κB pathway in the lung tissue.

Abstract:Objective: To investigate the influence of circular RNA FBLIM1 (circFBLIM1) on proliferative and invasion abilities of hepatocellular carcinoma (HCC) cells.
Methods: The HCC cell lines HepG2, 7402 and 97H were transfected with circFBLIM1 interference sequences (si-circFBLIM1) and negative control sequences respectively. The transfection efficiency was examined by qRT-PCR, and then, the proliferative and invasion abilities of the cells were determined by CCK-8 assay and Transwell assay, respectively. Ten nude mice were randomized into two groups after subcutaneously inoculated with HepG2 cells, and were injected in situ with 40 μL si-circFBLIM1 and negative control sequences one time every 4 days. The volumes of the xenograft tumors were recorded every 4 days, and the xenograft tumors were completely enucleated and weighed after 28 d.
Results: The results of qRT-PCR showed that the circFBLIM1 expressions in the three different HCC cells were significantly reduced after si-circFBLIM1 transfection (all P<0.05). The results of CCK-8 assay and Transwell assay showed that the proliferative and invasion abilities of the three types of HCC cells were all significantly weakened after si-circFBLIM1 transfection (all P<0.05). The results of nude mouse tumor transplantation showed that the growth speed was significantly slow down, and both volume and weight were significantly reduced in the xenograft tumor with si-circFBLIM1 injection (all P<0.05).
Conclusion: CircFBLIM1 can promote the proliferation and invasion of HCC cells, and is probably an important regulatory factor for the malignant biological features of HCC. Inhibition of circFBLIM1 expression may be an effective therapeutic strategy against HCC.

Abstract:Objective: To investigate the predictive factors for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) and establish its predictive model. 
Methods: Eighty-four consecutive patients who underwent PD by laparotomy in the Department of Biliopancreatic Surgery of Xiangya Hospital Central South University from December 2017 to June 2019 were prospectively enrolled. The incidence rates of POPF and other complications were analyzed, and the relevant factors for POPF were screened out by multivariate Logistic regression, by which the predictive model for POPF was established.
Results: In the whole group of 84 patients undergoing PD, the incidence of POPF and overall postoperative complications were 41.7% (35/84) and 57.1% (48/84) respectively. In patients with POPF, the incidence rates of postoperative bile leakage, pulmonary complications and severe postoperative complications were increased, the length of postoperative hospital stay was prolonged and hospital cost was increased significantly compared with those without POPF (all P<0.05).  The results of univariate analysis showed that pancreas texture, pancreatic duct diameter, pathology, fistula risk score (FRS), drainage fluid amylase on postoperative day 1 (DFA1), drainage fluid bacterial culture postoperative day 1 (DFBC1) and serum albumin on postoperative day 1 (SA1) were significantly associated with POPF (all P<0.05) . The results of multivariate Logistic regression analysis demonstrated that DFA1 (OR=1.000, 95% CI=1.000–1.000), DFBC1 (OR=18.873, 95% CI=2.913–21.122) and SA1 (OR=0.842, 95% CI=0.721–0.983) were independent predictive factors for POPF (all P<0.05).  Of the predictive model for POPF after PD constructed based on the above three factors, and the area under the receiver operating characteristic curve was 0.911 (95% CI=0.850–0.972), and the positive predictive value and negative predictive value were 90.0% and 89.2% respectively. Goodness of fit test showed that there was no statistical difference between the model’s predicted value and actual observed value (χ2=3.773, P>0.05).
Conclusion: DFA1, DFBC1 and SA1 have great importance in predicting the occurrence of POPF after PD. The model established by integrating these three factors has a higher efficiency for predicting POPF, and can be used as the clinical guidance of postoperative management and treatment of post-PD patients.

Abstract:Objective: To investigate the clinical efficacy of minimally invasive procedures in treatment of infected pancreatic necrosis (IPN) complicated with duodenal fistula (DF).  
Methods: The clinical data of 155 consecutive patients with IPN treated in the Department of Biliopancreatic Surgery of Xiangya Hospital, Central South University from January 2015 to May 2019 were retrospectively analyzed, with emphasis on the clinical characteristics, minimally invasive surgical methods and clinical outcomes of the cases with DF among them.
Results: Among the 155 patients with IPN, 15 cases (9.7%) were complicated with DF. Of the 15 patients with concomitant DF, the median time span from onset to occurrence of DF was 2.9 (1–12) months; 2 cases underwent percutaneous catheter drainage (PCD) only, and 13 case underwent PCD plus minimal access retroperitoneal pancreatic necrosectomy (MARPN); 2 cases who underwent PCD plus MARPN died from uncontrollable sepsis and massive hemorrhage; the fistula spontaneously healed in the 13 cases after minimally invasive treatment and enteral nutrition support, with the median duration of the fistula of 1.5 (0.5–3) months; open surgical treatment was not required in any of them. The median follow-up of the 13 patients was 18 (2–36) months, 
all of them were alive and no infection or DF recurrence was noted. In IPN patients with DF compared with the 140 cases without DF, the length of total hospital stay was significantly prolonged (P<0.01), but the mortality and other clinical variables showed no significant differences (all P>0.05).
Conclusion: In qualified acute pancreatitis treatment center, minimally invasive surgery combined with effective enteral nutrition support is an effective method of treatment for IPN complicated with DF.

Abstract:Objective: To investigate the causes and treatment strategies for iliac limb occlusion following endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA). 
Methods: The clinical data of 130 AAA patients admitted in the Department of Vascular Surgery of Xiangya Hospital, Central South University during January 2016 to July 2018 were retrospectively collected, and the clinical data of those that developed postoperative iliac limb occlusion were analyzed.
Results: Of the 130 AAA patients who successfully underwent EVAR, 6 cases (4.61%) developed postoperative iliac limb occlusion, all of which were unilateral, and the average time to occurrence of occlusion was (55±87) d. The clinical manifestations of the patients mainly were intermittent claudication and rest pain. The treatment methods included embolectomy through a femoral arteriotomy plus femorofemoral bypass in 2 cases, iliac arterial stent placement in one case, and embolectomy through a femoral arteriotomy plus iliac arterial stent placement in 3 cases. The ischemic symptoms of the involved limb disappeared in all patients after operation. Postoperative follow-up was conducted for 12 months and no ischemic symptoms reappeared in any of them.
Conclusion: Iliac limb occlusion is one of the relatively common complications following EVAR, and the reasons include unfavorable features of the aneurysmal neck, iliac stent-graft distortion, and anatomical abnormalities of the distal landing zone of the iliac limb are risk factors for graft limb occlusion. Embolectomy by femoral arteriotomy and/or iliac arterial stent placement are effective treatment approaches.

Abstract:Pancreatic cancer stem cells play an important role in the occurrence, development and metastasis as well as the therapeutic resistance and recurrence of pancreatic cancer, but the regulatory mechanisms involved are still unclear. In-depth study of the role of specific microRNA in the regulation of pancreatic cancer stem cells is of great significance for elucidating the key mechanisms of pathogenesis of pancreatic cancer, and is expected to provide a new target for the diagnosis and treatment of pancreatic cancer.

Abstract:Colorectal cancer (CRC) is a kind of diseases causing serious threats to public health. Early diagnosis and timely treatment are crucial for improvement of the prognosis of CRC patients. In recent years, liquid biopsy plays an increasingly important role in clinical work because of its advantages of being non-invasive, real-time and repeatable. Here, the authors review various liquid biopsies techniques in clinical applications for CRC.