Quality assessment indictors and benchmarks for pancreatic surgery / 中华外科杂志

Pancreatic surgery is the most complex type of abdominal surgery,with high technical requirements and long learning curve,and the quality of surgery is directly related to the prognosis of the patients. In recent years,more and more indicators have been used to evaluate the quality of pancreatic surgery,such as operation time,intraoperative blood loss,morbidity,mortality, prognosis and so on,and different evaluation systems have been established,including benchmarking,auditing,outcome evaluation based on risk factor adjustment and textbook outcomes. Among them,the benchmark is the most widely used to evaluate surgical quality and is expected to become the standard for comparison among peers. This article reviews existing quality evaluation indicators and benchmarks for pancreatic surgery and anticipates its future application prospects.

Value and controversy of lymphadenectomy for pancreatic neuroendocrine neoplasms / 中国实用外科杂志

In recent years,with the progress of imaging and diagnostic technology,the detection rate of pancreatic neuroendocrine neoplasms has increased rapidly.However,its clinical manifestations are diverse,the rate of misdiagnosis is high,the therapeutic treatments are complex,and the guidelines for diagnosis and treatment are relatively imperfect,which has caused great trouble in clinical practice.Especially in surgical treatment,it is difficult to choose between preservation of pancreatic function and standard radical resection,especially for tumors less than 2 cm.At the same time,whether lymph node resection should be performed is another open question.Because it is difficult to carry out randomized controlled studies,most of the studies on this issue are long-span retrospective studies based on public databases,which are greatly influenced by factors such as time,medical level in different regions and different surgeons.It is the confounding factors that lead to inconsistent results.

The adequate number of lymph node dissection in pancreatic cancer radical surgery based on nodal staging score(with four-center cohort validation) / 中国实用外科杂志

OBJECTIVE: To estimate the number of lymph nodes(LNs)needed to be examined for adequate LN staging via nodal staging score(NSS).METHODS: A model was fitted based on 3989 pN + patients with resected primary pancreatic adenocarcinoma in the Surveillance,Epidemiology and End RESULTS:(SEER)database.The number of nodes to examine to achieve an N SS of 90% was used as the optimal number.The results were validated in node negative patients from the SEER cohort(2583 patients)and a local multicenter cohort(93 patients).RESULTS: Tumor size is a determinant for the extent of lymphadenectomy.According to the tumor size<2 cm and ≥2 cm,15 and 20 LNs would need to be examined to achieve90% confidence in a pN0 patient.As a result of missing node-positive case,the prevalence of nodepositive was adjusted from 60.7% to 71.0%.In the survival analysis,more LNs examined was shown to be correlated with better prognosis in patients with tumor ≥2 cm.CONCLUSION: The minimum number of LNs for adequate staging depends on the tumor size.The estimation provides a practical standard for evaluating the extent of LN yield for surgeons.