International consensus guidelines on robotic pancreatic surgery in 2023.

Background: With the rapid development of robotic surgery, especially for the abdominal surgery, robotic pancreatic surgery (RPS) has been applied increasingly around the world. However, evidence-based guidelines regarding its application, safety, and efficacy are still lacking. To harvest robust evidence and comprehensive clinical practice, this study aims to develop international guidelines on the use of RPS. Methods: World Health Organization (WHO) Handbook for Guideline Development, GRADE Grid method, Delphi vote, and the AGREE-II instrument were used to establish the Guideline Steering Group, Guideline Development Group, and Guideline Secretary Group, formulate 19 clinical questions, develop the recommendations, and draft the guidelines. Three online meetings were held on 04/12/2020, 30/11/2021, and 25/01/2022 to vote on the recommendations and get advice and suggestions from all involved experts. All the experts focusing on minimally invasive surgery from America, Europe and Oceania made great contributions to this consensus guideline. Results: After a systematic literature review 176 studies were included, 19 questions were addressed and 14 recommendations were developed through the expert assessment and comprehensive judgment of the quality and credibility of the evidence. Conclusions: The international RPS guidelines can guide current practice for surgeons, patients, medical societies, hospital administrators, and related social communities. Further randomized trials are required to determine the added value of RPS as compared to open and laparoscopic surgery.

Effects of ageing time on the properties of polysaccharide in tangerine peel and its bacterial community.

To evaluate the effect of aging time on the quality of tangerine peel (TP) from the perspective of TP polysaccharide (TPP), five polysaccharide samples with different aging times named TPP-0/1/5/10/15 were prepared. Under the conditions of pH 0.5, solid-liquid ratio 1:25 and 80 °C, the TPPs extraction yield ranged from 20.35% to 27.68%. Compared with TPP-0, TPP-1/5/10/15 possesses low molecular weight (Mw) and high methoxy group content. In addition, TPP-15 had the most potent antioxidant activity. And the content of acidic polysaccharides in TPPs was negatively correlated with neutral polysaccharides during aging. Based on the analysis of 16srDNA, the dominant bacteria (Brevundimonas and Pseudomonas) in TP-10 might be critical flora to affect TP quality. This study provided basic information on the relationship between the TPPs and aging time, which could promote a new view to develop TP, and shorten the aging time during TP production.

Study on the Pore Structure and Fractal Characteristics of Different Lithofacies of Wufeng-Longmaxi Formation Shale in Southern Sichuan Basin, China.

Gas content and flow characteristics are closely related to shale lithofacies, and significant differences exist in the pore structure and fractal characteristics among lithofacies. In this study, X-ray diffractometer (XRD), field-emission scanning electron microscopy (FE-SEM), gas adsorption (N2 and CO2), and fractal theory were employed to systematically characterize the pore attributes of the marine Wufeng-Longmaxi formation shales. The information of various pores and microfractures among lithofacies was extracted and quantified via high-resolution FE-SEM image stitching technology. Shales were classified into four types based on mineral compositions, and siliceous shales possess the largest SEM-based surface porosity (2.84%) and the largest pore volume (PV) (average 0.0243 cm3/g) as well as specific surface area (SSA) (average 28.06 m2/g). The effect of lithofacies variation on the PV of shale is minor. In contrast, the lithofacies variation has a significant impact on the SSA, and the SSA of siliceous shale is 39.11% higher than that of argillaceous shale. PV and SSA show strong positive correlation with the total organic carbon (TOC) content but negative correlation with clay minerals. Siliceous shales have the greatest fractal dimension D1 (pore surface roughness) (average 2.6821), which is contributed by abundant organic matter pores with more complicated boundaries. The largest fractal dimension D2 (pore structure complexity) (average 2.8263) is found in mixed shales, which is attributed to well-developed intraparticle (intraP) pores associated with carbonate mineral dissolution. This indicates that siliceous shales have the highest methane adsorption capacity and that shale gas desorption, diffusion, and seepage are more difficult in mixed shales.

Radioactive 125I seed implantation for pancreatic cancer with unexpected liver metastasis: A preliminary experience with 26 patients.

BACKGROUND: Preoperative diagnosis rate of pancreatic cancer has increased year by year. The prognosis of pancreatic cancer patients with unexpected liver metastasis found by intraoperative exploration is very poor, and there is no effective and unified treatment strategy. AIM: To evaluate the therapeutic effect of radioactive 125I seed implantation for pancreatic cancer patients with unexpected liver metastasis. METHODS: The demographics and perioperative outcomes of patients who underwent 125I seed implantation to treat pancreatic cancer with unexpected liver metastasis between January 1, 2017 and June 1, 2019 were retrospectively analyzed. During the operation, 125I seeds were implanted into the pancreatic tumor under the guidance of intraoperative ultrasound, with a spacing of 1.5 cm and a row spacing of 1.5 cm. For patients with obstructive jaundice and digestive tract obstruction, choledochojejunostomy and gastroenterostomy were performed simultaneously. After operation, the patients were divided into a non-chemotherapy group and a chemotherapy group that received gemcitabine combined with albumin-bound paclitaxel treatment. RESULTS: Preoperative imaging evaluation of all patients in this study showed that the tumor was resectable without liver metastasis. There were 26 patients in this study, including 18 males and 8 females, aged 60.5 ± 9.7 years. The most common tumor site was the pancreatic head (17, 65.4%), followed by the pancreatic neck and body (6, 23.2%) and pancreatic tail (3, 11.4%). Fourteen patients (53.8%) underwent palliative surgery and postoperative pain relief occurred in 22 patients (84.6%). The estimated blood loss in operation was 148.3 ± 282.1 mL and one patient received blood transfusion. The postoperative hospital stay was 7.6 ± 2.8 d. One patient had biliary fistula, one had pancreatic fistula, and all recovered after conservative treatment. After operation, 7 patients received chemotherapy and 19 did not. The 1-year survival rate was significantly higher in patients who received chemotherapy than in those who did not (68.6% vs 15.8%, P = 0.012). The mean overall survival of patients in the chemotherapy group and non-chemotherapy group was 16.3 mo and 10 mo, respectively (χ 2 = 7.083, P = 0.008). CONCLUSION: Radioactive 125I seed implantation combined with postoperative chemotherapy can prolong the survival time and relieve pain of pancreatic cancer patients with unexpected liver metastasis.

Robotic resection of duodenal gastrointestinal stromal tumour: Preliminary experience from a single centre.

BACKGROUND: Experience in minimally invasive surgery in the treatment of duodenal gastrointestinal stromal tumors (DGISTs) is accumulating, but there is no consensus on the choice of surgical method. AIM: To summarize the technique and feasibility of robotic resection of DGISTs. METHODS: The perioperative and demographic outcomes of a consecutive series of patients who underwent robotic resection and open resection of DGISTs between May 1, 2010 and May 1, 2020 were retrospectively analyzed. The patients were divided into the open surgery group and the robotic surgery group. Pancreatoduodenectomy (PD) or limited resection was performed based on the location of the tumour and the distance between the tumour and duodenal papilla. Age, sex, tumour location, tumour size, operation time (OT), estimated blood loss (EBL), postoperative hospital stay (PHS), tumour mitosis, postoperative risk classification, postoperative recurrence and recurrence-free survival were compared between the two groups. RESULTS: Of the 28 patients included, 19 were male and 9 were female aged 51.3 ± 13.1 years. Limited resection was performed in 17 patients, and PD was performed in 11 patients. Eleven patients underwent open surgery, and 17 patients underwent robotic surgery. Two patients in the robotic surgery group underwent conversion to open surgery. All the tumours were R0 resected, and there was no significant difference in age, sex, tumour size, operation mode, PHS, tumour mitosis, incidence of postoperative complications, risk classification, postoperative targeted drug therapy or postoperative recurrence between the two groups (P > 0.05). OT and EBL in the robotic group were significantly different to those in the open surgery group (P < 0.05). All the patients survived during the follow-up period, and 4 patients had recurrence and metastasis. No significant difference in recurrence-free survival was noted between the open surgery group and the robotic surgery group (P > 0.05). CONCLUSION: Robotic resection is safe and feasible for patients with DGISTs, and its therapeutic effect is equivalent to open surgery.

Radioactive 125I seed implantation for locally advanced pancreatic cancer: A retrospective analysis of 50 cases.

BACKGROUND: Pancreatic cancer is one of the common malignant tumors of the digestive system, and radical resection is the first choice of treatment for pancreatic cancer. If patients with locally advanced pancreatic cancer cannot be treated in time and effectively, their disease often develops rapidly and their survival period is very short. AIM: To evaluate the therapeutic effect of 125I seed implantation in patients with locally advanced pancreatic cancer. METHODS: The demographics and perioperative outcomes of a consecutive series of patients who underwent 125I seed implantation to treat locally advanced pancreatic cancer between January 1, 2017 and June 30, 2019 were retrospectively analyzed. According to the results of preoperative computed tomography or magnetic resonance imaging, the treatment planning system was used to determine the area and number of 125I seeds implanted. During the operation, 125I seeds were implanted into the tumor under the guidance of intraoperative ultrasound, with a spacing of 1.5 cm and a row spacing of 1.5 cm. For patients with obstructive jaundice and digestive tract obstruction, choledochojejunostomy and gastroenterostomy were performed simultaneously. After operation, the patients were divided into a non-chemotherapy group and a chemotherapy group that received gemcitabine combined with albumin-bound paclitaxel treatment. RESULTS: Among the 50 patients, there were 29 males and 21 females, with a mean age of 56.9 ± 9.8 years. The main reason for the failure of radical resection was superior mesenteric artery invasion (37, 74%), followed by superior mesenteric vein invasion (33, 66%). Twenty-one (62%) patients underwent palliative surgery and postoperative pain relief occurred in 40 (80%) patients. The estimated blood loss in operation was 107.4 ± 115.3 mL and none of the patient received blood transfusion. The postoperative hospital stay was 7.5 ± 4.2 d; one patient had biliary fistula and three had pancreatic fistula, all of whom recovered after conservative treatment. After operation, 26 patients received chemotherapy and 24 did not. The 1-year survival rate was significantly higher in patients who received chemotherapy than in those who did not (60.7% vs 35.9%, P = 0.034). The mean overall survival of patients of the chemotherapy group and non-chemotherapy group was 14 and 11 mo, respectively (χ 2 = 3.970, P = 0.046). CONCLUSION: Radioactive 125I seed implantation combined with postoperative chemotherapy can prolong the survival time, relieve pain, and improve the quality of life of patients with locally advanced pancreatic cancer.