Abstract:Hepatectomy has become the most important treatment method for hepatobiliary diseases. The perioperative management of hepatectomy is closely related to its safety and efficacy. Perioperative management includes systematic evaluation and management of the patient′s condition before, during, and after surgery, and its principles and methods have developed rapidly in recent years. In 2017, the Group of Liver Surgery of Surgical Society of Chinese Medical Association released the "Expert consensus on perioperative management of hepatectomy". On this basis, the editorial committee has reviewed existing evidence-based medicine research evidence, combined with the latest clinical practice experience of numerous liver surgery centers at home and abroad, organized a multidisciplinary expert team in relevant fields in China for discussion, and revised to formulate the Guidelines for multidisciplinary clinical management of perioperative period of hepatectomy (2025 edition). This guideline covers a systematic assessment, treatment principles, and methods for relevant conditions before, during, and after hepatectomy, and provides specific recommendations. The revision of the guidelines aims to promote the standardization and refinement of clinical practice in this field, improve the safety and clinical efficacy of liver resection, and provide guidance and reference for clinical professionals related to liver surgery.

Abstract:The incidence of acute hypertriglyceridemic pancreatitis (HTG-AP) has been rising, with high recurrence and poor long-term outcomes. Current guidelines mainly address the acute phase, leaving a gap in standardized recovery-phase management. To fill this gap, the Zhejiang Provincial Preventive Medicine Association, together with multidisciplinary experts nationwide, developed this consensus based on evidence and clinical practice. The document highlights key aspects including etiology identification and recurrence risk assessment, triglyceride control targets, lifestyle and pharmacologic interventions, nutritional and gut microbiota management, prevention of complications and comorbidities, psychological and traditional Chinese medicine interventions, as well as structured follow-up and multidisciplinary team care. Practical recommendations are proposed to standardize and individualize management during recovery, aiming to reduce recurrence risk and improve long-term outcomes in patients with HTG-AP.

Abstract:In 2025, the International Association of Pancreatology (IAP), in collaboration with the American Pancreatic Association, European Pancreatic Club, Indian Pancreas Club, and Japan Pancreas Society, released the International Association of Pancreatology revised guidelines on acute pancreatitis 2025. This edition represents a comprehensive revision of the 2013 guidelines, based on high-quality evidence accumulated over the past decade, particularly randomized controlled trials. The guidelines encompass 18 key areas-including pain management, fluid therapy, nutritional support, management of infected necrosis, complication control, discharge and follow-up, and recurrence prevention-offering a total of 96 recommendations that emphasize individualized treatment. These updates provide important guidance for standardizing clinical practice and improving outcomes in acute pancreatitis, while also indicating future research directions such as the development of targeted therapies. However, some recommendations remain limited by lower evidence quality, uncertain applicability in specific clinical settings, and insufficient consideration of economic burden and cost-effectiveness.

Abstract:Pancreaticoduodenectomy (PD) remains one of the most complex and high-risk procedures in abdominal surgery, with clinically relevant postoperative pancreatic fistula (CR-POPF) being a significant determinant of morbidity and mortality. Recent evidence suggests that merely modifying the pancreatoenteric anastomosis technique fails to achieve a consistent reduction in fistula incidence. The Department of Pancreatic Surgery at Zhongshan Hospital, Fudan University, has developed a prophylactic dual biliary-pancreatic diversion system that simultaneously drains bile and pancreatic juice during PD. This system provides dual protection through "decompression and separation," preventing premature activation of pancreatic enzymes and reducing anastomotic stress. This article introduces the system's conceptual framework, design principles, and clinical application, summarizes ongoing multicenter randomized controlled trials, and discusses key issues, including indication selection, intraoperative management, external drainage care, and patient compliance. Furthermore, it outlines future directions in risk stratification, antimicrobial stewardship, intelligent drainage, and biomaterial innovation. As a conceptual and translational advance, this dual diversion strategy may redefine the paradigm of postoperative complication prevention after PD.

Abstract:Pancreatic surgery remains one of the most challenging fields in general surgery due to its complex anatomy and high risk of complications. In recent years, the integration of digital intelligent technologies-such as three-dimensional (3D) reconstruction, fluorescence navigation, augmented/mixed reality (AR/MR), and artificial intelligence (AI)-has provided new strategies for achieving precision, safety, and intelligence in pancreatic surgery. This review summarizes the innovations and clinical applications of these technologies throughout the full perioperative process, including preoperative planning, intraoperative navigation, and postoperative monitoring. Preoperatively, the deep learning-based nnU-Net framework enables high-precision 3D reconstruction of peripancreatic vessels and pancreaticobiliary ducts for individualized surgical planning. Intraoperatively, multimodal image fusion combining indocyanine green fluorescence imaging with AR/MR navigation allows real-time visualization and spatial localization of key anatomical structures, enhancing surgical accuracy and safety. Postoperatively, AI-driven models integrated with wearable sensors and multimodal data support intelligent risk prediction and early intervention for complications. The systematic application of digital intelligence is reshaping the paradigm of pancreatic surgery, driving the transition from experience-based to data-driven and from surgeon-dependent to intelligent decision-making. With continuous algorithmic refinement and accumulation of clinical evidence, digital empowerment will further advance pancreatic surgery toward personalization, precision, and intelligence.

Abstract:Pancreatic duct stents are essential devices for managing chronic pancreatitis, ductal strictures, and postoperative fistula. Conventional plastic and metal stents effectively facilitate pancreatic drainage but often cause infection, restenosis, or migration upon long-term implantation. An ideal stent should provide excellent biocompatibility, efficient drainage, and controllable biodegradation. With advances in material science and medical-engineering integration, stent technology has evolved from inert implantation to intelligent degradation. Biodegradable polymers and metals, particularly magnesium alloys (Mg-Zn-Mn), offer tunable mechanical strength, corrosion resistance, and in vivo degradability. Mg-2Zn-1.0Mn alloy achieves balanced strength and corrosion control through compositional optimization and surface modification. Polymeric stents such as polylactic acid and polydioxanone demonstrate favorable drainage and avoid secondary removal. Composite biodegradable stents, exemplified by the multi-rate ARCHIMEDES model, have received international approval. Supported by 3D printing and smart functionalization-such as drug-eluting or shape-memory designs-next-generation pancreatic stents may achieve integrated functions of support, repair, and tumor inhibition. Future research should emphasize interdisciplinary material design, degradation kinetics under physiological conditions, and long-term biocompatibility to accelerate clinical translation.

Abstract:Background and Aims Early-onset extensive emphysematous pancreatitis (EP) is a rare but highly lethal subtype of infected pancreatic necrosis (IPN), characterized by abrupt onset and rapid deterioration. This study aimed to investigate its clinical characteristics, microbiological spectrum, treatment approaches, and outcomes to provide evidence for early identification and timely intervention.Methods A retrospective analysis was performed on 305 IPN patients treated at Xiangya Hospital, Central South University, from January 2010 to October 2023. Eight patients who developed gas accumulation involving ≥50% of pancreatic or peripancreatic necrosis within two weeks of onset were defined as early-onset extensive EP. Their clinical data were compared with those of ordinary IPN patients.Results Early-onset extensive EP accounted for 2.6% of all IPN cases. The early-onset extensive EP group had significantly higher mortality and multiple organ failure rates compared with the ordinary IPN group (75.0% vs. 24.6% and 75.0% vs. 34.7%, respectively; both P<0.05). A total of 15 microbial isolates were identified from early-onset extensive EP patients, predominantly Klebsiella pneumoniae (62.5%) and Escherichia coli (37.5%). The infection rate of carbapenem-resistant Enterobacteriaceae (CRE) was markedly higher in the EP group than in the ordinary IPN group (75.0% vs. 31.1%, P=0.015). Most patients were treated using a step-up approach based on percutaneous catheter drainage, with no significant difference in treatment strategy between the two groups (P=0.625).Conclusion Early-onset extensive EP represents a rare and fulminant subtype of IPN with extremely poor outcomes. Klebsiella pneumoniae and CRE are the predominant pathogens. Early radiological evaluation and timely intervention are crucial for improving prognosis in these patients.

Abstract:Background and Aims Infected necrotizing pancreatitis (INP), particularly with diffuse distribution, is a life-threatening condition. The optimal initial intervention-minimally invasive step-up therapy vs. direct open necrosectomy-remains controversial. Moreover, the impact of necrosis morphology ("wet" or "dry") and the presence of severe acute pancreatitis (SAP) on treatment selection has not been fully clarified. This study aimed to compare the efficacy and safety of these two approaches in diffuse INP and to evaluate the guiding value of CT-based necrosis type and SAP status in clinical decision-making.Methods A retrospective analysis was conducted on 458 patients with diffuse INP admitted to the Third Xiangya Hospital of Central South University from January 2012 to March 2023. Patients were divided into a minimally invasive step-up group (n=256) and a direct open surgery group (n=202). SAP was defined according to the determinant-based classification, and necrosis was categorized as "wet" or "dry" based on CT features. The primary endpoint was a composite of death or major complications, while secondary endpoints included mortality, length of hospital stay, and incision-related complications, were compared between the two groups, with subgroup analyses performed accordingly.Results Overall, the open surgery group had higher rates of the primary endpoint (62.4% vs. 48.1%, P=0.003) and mortality (27.2% vs. 16.8%, P=0.008) compared with the step-up group. Among SAP patients, the step-up approach resulted in a significantly lower primary endpoint rate (66.7% vs. 97.7%, P=0.003). In non-SAP patients, the primary endpoint rates were similar, but open surgery was associated with a shorter hospital stay [(36.5±10.4) d vs. (45.6±18.6) d, P<0.001] and higher incidences of wound infection and incisional hernia (both P<0.001). Multivariate analysis identified infection onset time, effusion characteristics, gas bubbles, and necrosis location as independent predictors of prolonged hospitalization in the step-up group (all P<0.05). Patients with "wet" necrosis benefited more from the step-up approach, whereas those with "dry" necrosis experienced shorter hospitalization following open surgery.Conclusion For diffusely distributed INP, treatment strategies should be individualized based on SAP status and necrosis liquefaction/imaging characteristics. The step-up minimally invasive approach is preferred for SAP patients and those with "wet" necrosis on CT, while direct open necrosectomy may be advantageous for "dry" necrosis (particularly with limited liquefaction) by shortening hospital stay and reducing certain major outcomes, though at the cost of increased incision infection and incision herina. CT imaging features and SAP classification can serve as valuable tools for risk stratification and guiding individualized timing and modality of intervention.

Abstract:Background and Aims Acute pancreatitis (AP) is an acute inflammatory disease of the pancreas caused by abnormal activation of pancreatic enzymes. Although gallstones, hyperlipidemia, and alcohol use are the most common causes, a subset of patients develop AP secondary to rare etiologies that are often misdiagnosed or diagnosed late, leading to recurrence or inappropriate management. This study aims to summarize the clinical characteristics, diagnostic strategies, and treatment outcomes of four cases of AP caused by uncommon etiologies, supported by a literature review.Methods Clinical data of 4 patients admitted to the Department of Hepatobiliary and Pancreatic Surgery, the Third Xiangya Hospital of Central South University, between November 2021 and September 2024, were retrospectively analyzed. Their etiological characteristics, diagnostic approaches, and treatment strategies were reviewed in combination with relevant literature.Results The underlying causes of AP were intraductal papillary mucinous neoplasm, pancreatic neuroendocrine tumor, pancreatic ductal adenocarcinoma, and duodenojejunal intussusception. All cases initially presented as idiopathic AP. Three patients underwent definitive surgical treatment and recovered well, while one patient with pancreatic cancer received only palliative care due to delayed diagnosis and died three months later.Conclusion AP secondary to rare etiologies often mimics common forms in clinical presentation but poses diagnostic challenges. For patients with recurrent or idiopathic AP, clinicians should emphasize etiological tracing and utilize advanced imaging and endoscopic modalities for early identification. Timely etiological intervention, particularly surgical management when appropriate, is essential for preventing recurrence and improving prognosis.

Abstract:Background and Aims Laparoscopic pancreaticoduodenectomy (LPD) has become a preferred approach for periampullary tumors, yet delayed gastric emptying (DGE) remains a frequent complication that hampers postoperative recovery. The nasojejunal feeding tube (NJT) is commonly used for early enteral nutrition, but its impact on DGE is controversial. This study aimed to evaluate whether intraoperative NJT placement increases the risk of DGE after LPD and to assess its influence on postoperative recovery outcomes.Methods A retrospective cohort of 319 patients who underwent LPD at Provincial Hospital Affiliated to Shandong First Medical University from April 2017 to November 2023 was analyzed. Patients were divided into two groups based on intraoperative NJT placement (NJT group, n=200; non-NJT group, n=119). The incidence of DGE and postoperative outcomes were compared. Multivariate logistic regression and propensity score matching (PSM) were performed to identify independent risk factors for DGE.Results The incidence of grade B/C DGE was significantly higher in the NJT group than in the non-NJT group (36.5% vs. 21.8%, P=0.006). NJT placement was associated with longer postoperative hospital stay and higher hospitalization costs (both P<0.05). Multivariate analysis revealed intraoperative NJT placement (OR=1.960, 95% CI=1.142-3.363, P=0.015) and intraoperative blood loss >400 mL (OR=1.921, 95% CI=1.155-3.194, P=0.012) as independent risk factors for DGE. These findings were consistent after PSM.Conclusions Prophylactic intraoperative NJT placement confers no additional benefit for postoperative recovery after LPD and is associated with a higher risk of DGE, prolonged hospitalization, and increased medical costs. Routine NJT placement should therefore be avoided, and individualized strategies should be adopted to minimize postoperative complications and enhance recovery

Abstract:Background and Aims Pancreatic cancer is one of the most aggressive malignancies of the digestive system and is associated with an inferior prognosis. In recent years, its incidence has shown a trend toward younger onset. Early-onset pancreatic cancer (EOPC), defined as pancreatic cancer diagnosed at ≤50 years of age, has been increasing annually and may possess distinct biological and prognostic characteristics. Given the limited data from China, this study aimed to investigate the clinicopathological features and prognostic outcomes of EOPC patients.Methods Clinical data of 113 patients with EOPC admitted to Xiangya Hospital, Central South University, from January 2017 to December 2023 were retrospectively analyzed. Variables included demographic characteristics, clinicopathological features, and survival information. Kaplan-Meier survival curves were plotted, and differences in survival between the surgical and non-surgical groups were compared.Results The median age at diagnosis was 46 (42-49) years, and males accounted for 65.49% of cases. Blood type A (40.71%) and type O (34.51%) were most common. The main presenting symptoms were abdominal pain (69.91%), weight loss (62.83%), jaundice (43.36%), and abdominal distension (36.28%). Imaging findings showed bile duct dilation in 32.74%, pancreatic duct dilation in 39.82%, vascular invasion in 59.29%, and distant metastasis in 52.21% of patients. Histopathology revealed that adenocarcinoma and ductal adenocarcinoma accounted for 93.81% of all cases, with predominantly moderate or poor differentiation (76.10%). Tumors were the most frequently located in the pancreatic head (65.42%). TNM staging showed lymph node metastasis in 77.88% and stage Ⅳ disease in 52.21%. Laboratory tests demonstrated markedly elevated CA19-9 levels. Kaplan-Meier analysis indicated a median overall survival of 18.6 months for the entire cohort, with significantly longer survival in the surgical group compared with the non-surgical group (29.4 months vs. 13.8 months, P=0.001 5).Conclusion EOPC predominantly affects males and tends to arise in the pancreatic head. It is often diagnosed at an advanced stage or with distant metastasis and is characterized by poor differentiation and strong invasiveness. Surgical resection markedly improves survival and remains the key to prolonged prognosis. Young individuals presenting with unexplained abdominal pain, weight loss, or jaundice should be carefully evaluated through imaging to enable early diagnosis and timely surgical intervention. Future multicenter, large-sample prospective studies are warranted to validate these findings further.

Abstract:Background and Aims Pancreatic cancer is a highly malignant digestive system tumor characterized by poor prognosis and limited therapeutic response. The tumor microenvironment plays a crucial role in its progression, where oxidative stress and lactate metabolism are two tightly interconnected processes influencing tumor growth, immune escape, and therapeutic resistance. However, their combined prognostic impact remains poorly understood. This study aimed to integrate oxidative stress– and lactate metabolism-related genes to establish and validate a robust prognostic model for pancreatic cancer, and to explore its association with immune microenvironment characteristics.Methods Transcriptomic and clinical data of 177 pancreatic cancer patients were obtained from TCGA database and an external validation was performed using the GEO dataset (GSE57495). Differentially expressed genes associated with oxidative stress and lactate metabolism were identified using the "limma" package. Univariate Cox regression was used to screen prognostic genes, followed by LASSO regression to construct a multi-gene risk model. Model performance was evaluated by Kaplan-Meier survival analysis, receiver operating characteristic (ROC) curves, concordance index (C-index), nomogram calibration, and decision curve analysis (DCA). The CIBERSORT and ssGSEA algorithms were used to analyze immune cell infiltration and immune functional differences between risk groups.Results A six-gene signature (MUC1, KRT18, SDC1, AREG, DDC, and ATPAF2) was identified to construct the prognostic model. Based on the calculated risk score, patients were stratified into high- and low-risk groups. Kaplan-Meier analysis revealed significantly worse overall survival in the high-risk group (P<0.01). The model showed good predictive accuracy with 1-, 2-, and 3-year AUCs of 0.710, 0.674, and 0.649, respectively. The C-index and calibration curves confirmed its reliability, and multivariate Cox regression indicated that the risk score was an independent prognostic factor. External validation using GEO data demonstrated consistent predictive performance. Immune infiltration analysis revealed that M0 macrophages were markedly enriched in the high-risk group, while cytotoxic and effector T-cell populations were reduced, suggesting that an immunosuppressive microenvironment may contribute to poor outcomes.Conclusion This study developed and validated a novel prognostic model for pancreatic cancer based on oxidative stress and lactate metabolism-related genes. The model accurately predicts patient survival, reflects immune microenvironment heterogeneity, and provides new molecular insights for risk stratification and individualized therapeutic strategies in pancreatic cancer management.

Abstract:Background and Aims Pancreatic cancer (PC) is a highly lethal malignancy with poor prognosis and limited early diagnostic tools. Although numerous serum metabolites have been associated with PC risk in observational studies, the causal nature of these associations remains uncertain. This study aimed to evaluate the genetic causal relationships between serum metabolites and PC risk, identify PC-related risk genes, and elucidate the gene-metabolite-PC causal network.Methods Two-sample Mendelian randomization (TSMR) and summary-data-based Mendelian randomization (SMR) analyses were performed by integrating GWAS data of 325 serum metabolites, GTEx v8 pancreatic tissue eQTL data, and FinnGen R12 PC GWAS data. The study assessed causal effects of metabolites on PC risk, identified risk-associated genes, and explored the potential mediating role of metabolites between genes and PC.Results Four serum metabolites showed significant causal relationships with PC risk. Elevated serum albumin (OR=1.456, P=0.003) and free cholesterol percentage in small high-density lipoprotein (HDL) (OR=1.189, P=0.005) were associated with increased PC risk, whereas higher phospholipid percentages in intermediate-density lipoprotein (IDL) and small HDL were protective (OR=0.792 and 0.836, respectively; both P<0.01). SMR analysis identified 196 PC-related genes, including risk genes such as DGKQ, CDC37P1, and SULT1A2, and protective genes such as PALMD and HEG1. Thirty-two significant gene-metabolite causal pairs were further confirmed, indicating potential mediation of PC genetic risk through specific metabolic pathways.Conclusion This study systematically clarified the causal relationships between serum metabolites and pancreatic cancer risk and established a gene-metabolite regulatory network. The findings highlight the central role of lipid metabolism in PC development and provide molecular evidence for early detection and personalized prevention strategies.

Abstract:Background and Aims Gastric cancer remains a common malignancy worldwide with a poor prognosis and limited response to current therapies. Ferroptosis, a novel form of regulated cell death, has emerged as a promising therapeutic target in cancer. Terminal nucleotidyltransferase 5B (TENT5B) is downregulated in various tumors, but its role in gastric cancer and ferroptosis remains unclear. This study aimed to investigate the expression pattern and biological function of TENT5B in gastric cancer and to elucidate its underlying mechanisms in regulating ferroptosis.Methods The expression of TENT5B in gastric cancer was analyzed using TCGA and GEO datasets, and further validated in gastric cancer tissues and cell lines by qRT-PCR and Western blotting. CCK-8, colony formation, wound healing, and Transwell assays were performed to evaluate the effects of TENT5B overexpression on cell proliferation and migration. Ferroptosis was assessed by measuring cell viability, lipid ROS, and MDA levels. Bioinformatics analysis, mRNA stability assays, and rescue experiments were conducted to explore the molecular mechanisms. A subcutaneous xenograft mouse model was used to validate the in vivo effects.Results TENT5B was significantly downregulated in gastric cancer tissues and cells. Overexpression of TENT5B inhibited cell proliferation and migration while promoting ferroptosis. Mechanistically, TENT5B enhanced PRKAA2 mRNA stability and upregulated its expression, thereby exerting tumor-suppressive effects. In vivo, TENT5B overexpression suppressed tumor growth and elevated PRKAA2 expression.Conclusion TENT5B functions as a tumor suppressor in gastric cancer by stabilizing PRKAA2 mRNA, promoting ferroptosis, and inhibiting cancer progression. These findings suggest that TENT5B may serve as a promising molecular target for ferroptosis-based therapeutic strategies in gastric cancer.

Abstract:Background and Aims Conversion therapy offers initially unresectable hepatocellular carcinoma (HCC) patients a chance for curative resection. However, the optimal margin width following conversion remains unclear. This study aimed to evaluate the impact of surgical margin width on prognosis and identify independent prognostic factors in HCC patients undergoing hepatectomy after conversion therapy.Methods A retrospective analysis was performed on 413 patients with initially unresectable HCC who received conversion therapy and underwent radical resection at Cancer Prevention and Control Center of Sun Yat-sen University between February 2015 and June 2022. According to the intraoperatively measured pathological margin, patients were classified into two groups: tumor margin <1 cm and ≥1 cm, and further divided into subgroups with margins of 0 cm, 0.1 cm, and >0.1 cm to compare survival differences among groups. The Kaplan–Meier method and Cox proportional hazards model were used to evaluate disease-free survival (DFS), overall survival (OS), and their influencing factors.Results The 3-year OS and DFS showed no significant difference between the <1 cm and ≥1 cm groups (both P>0.05). However, patients with a 0 cm margin had significantly worse OS than those with a 0.1 cm margin (P=0.048). No significant survival difference was observed in OS and DFS between the 0.1 cm and >0.1 cm groups (both P>0.05). Multivariate analysis identified multiple tumors, poor differentiation, and microvascular invasion as independent adverse prognostic factors for both OS and DFS (all P<0.05), whereas targeted therapy was an independent protective factor for DFS (P=0.014).Conclusion A pathological margin ≥0.1 cm provides comparable survival to wider margins and can be considered a safe threshold for HCC patients undergoing hepatectomy after conversion therapy. The conventional 1 cm margin standard offers no additional benefit. Multiple tumors, poor differentiation, and microvascular invasion predict poor prognosis, while targeted and immunotherapy during conversion may improve long-term outcomes.

Abstract:Pancreatic cancer is highly aggressive and often diagnosed at an advanced stage, leaving most patients ineligible for radical resection. This study retrospectively analyzed four patients with locally advanced or advanced pancreatic cancer to evaluate the clinical efficacy and safety of high-intensity focused ultrasound (HIFU) ablation combined with chemotherapy as a neoadjuvant and conversion therapy. All cases were reviewed and individualized treatment plans were formulated through a multidisciplinary team evaluation. All patients received HIFU plus gemcitabine and nab-paclitaxel chemotherapy, with assessments of tumor volume, vascular involvement, surgical conversion, symptom relief, and adverse events. Three patients achieved marked tumor shrinkage and reduction of vascular invasion, enabling successful R₀ resection without recurrence during follow-up. The remaining patient achieved disease stability, significant pain relief, and maintained good quality of life under repeated HIFU therapy. All treatments were well tolerated, and no severe adverse reactions occurred. The combination of HIFU and chemotherapy demonstrated synergistic local and systemic effects, effectively achieving tumor downstaging, improving resectability, and alleviating symptoms. As a safe, noninvasive, and repeatable therapeutic approach, this strategy offers a promising option for patients with advanced pancreatic cancer. Further large-scale prospective studies are warranted to validate its long-term efficacy and elucidate underlying mechanisms.

Abstract:Agenesis of the dorsal pancreas (ADP) is an extremely rare congenital pancreatic malformation characterized by the absence or hypoplasia of the pancreatic body and tail. Its pathogenesis is closely related to abnormal embryonic development of the ventral and dorsal pancreatic buds, governed by a complex network of transcription factors, including HLXB9, HNF1B, PDX1, PTF1A, GATA4, and GATA6. The clinical spectrum of ADP is highly variable, ranging from asymptomatic cases to manifestations such as abdominal pain, diabetes mellitus, or pancreatitis. Imaging modalities-including ultrasonography, CT, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangio-pancreatography-serve as the main diagnostic tools, with characteristic findings of absent pancreatic body and tail accompanied by compensatory enlargement of the pancreatic head. ADP is frequently associated with congenital anomalies of the kidney, biliary tract, cardiovascular system, or genital organs. Management is primarily symptomatic, with insulin replacement for diabetes and pancreatic enzyme supplementation for exocrine insufficiency. Advances in genetic sequencing and stem cell research have deepened understanding of the pathogenesis, genetic background, and potential therapeutic strategies of ADP. This review summarizes current progress in embryology, genetics, clinical features, diagnosis, and treatment of ADP, aiming to improve clinical recognition and guide future investigations.

Abstract:Cholangiocarcinoma (CCA) is a malignant tumor originating from the epithelial cells of the bile ducts, with its incidence and mortality rates rising in recent years, particularly in Asia. Because the early symptoms of CCA are often insidious and nonspecific, most patients are diagnosed at an advanced stage and lose the opportunity for radical surgical treatment. Although chemotherapy remains the main first-line therapy, its efficacy is limited. With the rapid development of next-generation sequencing technologies and the growing emphasis on individualized precision medicine, our understanding of the molecular biology of CCA has deepened substantially. Research on molecular targeted therapy, immunotherapy, and combination strategies integrating both approaches has made remarkable progress. This article provides an overview of the molecular targets, immune microenvironment, immune checkpoint inhibitors, and therapeutic strategies related to CCA.