Necrotizing pancreatitis (NP) is a complicated and challenging condition due to the incidence of NP-related complications over the course of disease. As a key role of MDT team, how to properly select the indications and timing of interventions, thereby avoiding insufficient or excessive interventions for patients, has become the key and challenging task in clinical treatment for surgeons. In addition, under the background of diversified intervention models for pancreatitis, how to choose individualized and professional treatment regimens according to the disease progression characteristics of patients, effectively control secondary injury and improve the overall cure rate are also the top priorities of existing treatment for NP. In this article, surgical interventions for NP-related complications were illustrated combined with clinical practice, aiming to improve clinical prognosis of these patients.

Neuroendocrine neoplasms (NENs) are heterogeneous neoplasms. NENs arising from the stomach, bowel and pancreas can be divided into high-differentiated neuroendocrine tumors (NET) and neuroendocrine carcinoma, among which high-differentiated NET can be subdivided into NET G1, G2 and NET G3 according to Ki-67 index, and classified into functional NET and non-functional NET according to the function of hormone secretion. NF-NET is the dominant type, manifested with elusive onset. Many patients have local progression and/or distant metastasis upon diagnosis. Transformation therapy is of significance for patients with advanced NET. In this article, common transformation therapies were summarized based on different biological behaviors of advanced tumors. According to the characteristics of different types of tumors, appropriate treatment approaches were determined. Drug combination therapy should be carried out to achieve precise and individualized treatment when necessary.

Surgical resection is the most effective treatment for benign and low-grade malignant pancreatic tumors. However, classical pancreatectomy constantly requires simultaneous resection of organs surrounding pancreatic tissues, which has the disadvantages of severe trauma, high-risk complications and poor long-term quality of life. In order to preserve organ function as much as possible, multiple organ-preserving pancreatectomy have been widely applied in clinical practice, which mainly include tumor enucleation, central pancreatectomy, spleen-preserving distal pancreatectomy and duodenum-preserving pancreatic head resection, etc. In recent years, with the advancement of minimally invasive technologies, robotic organ-preserving pancreatectomy has also been carried out in clinical setting. In this article, clinical application status of robotic organ function-preserving pancreatectomy was mainly illustrated.

Chronic pancreatitis is a refractory disease that severely affects the quality of life of patients. At present, the step-by-step approach of "medicine-endoscopy-surgery" is the main mode of treatment for this disease. However, with deepening understanding of the disease, especially in-depth study of its mechanism of pain, traditional treatment strategy has also undergone novel changes. The concept and practice of early surgery have shown unique advantages in the full-course treatment of chronic pancreatitis. In this article, focusing on the efficacy of early surgical intervention and the selection of surgical approaches, the significance and value of early surgery were deeply discussed, and the optimal treatment combining with suitable surgical approaches for patients with chronic pancreatitis under different circumstances was summarized.

Hemorrhage is a threatening complication after pancreatic surgery, which severely affects the life of patients due to rapid onset and difficult diagnosis. According to different types of diseases, the sites and approaches of pancreatic surgery, and the causes of postoperative pancreatic hemorrhage (PPH) significantly differ. With the improvement of surgical methods and rapid development of interventional techniques, surgeons have more options to treat postoperative bleeding. Corresponding measures should be taken to manage perioperative bleeding for pancreatic surgery. The diagnosis should be made based on laboratory and imaging examinations. Preoperative reduction of jaundice, transfusion of frozen plasma, platelets and vitamin K can be performed to improve coagulation function. Precise intraoperative operation can avoid vascular injury. Appropriate suturing, bandage and sealer should be adopted to achieve precise hemostasis. Postoperatively, the drainage tube should be maintained patent to avoid abdominal infection caused by delayed detection of bleeding or poor drainage of pancreatic fistula. Abdominal ultrasound and CT scan should be performed timely to identify pancreatic fistula and deliver drainage treatment. Extensive attention should be diverted to the phenomenon of sentinel bleeding. Effective measures should be taken to reduce the occurrence of PPH. In this article, the definition, causes, diagnosis and treatment of PPH were reviewed, aiming to provide further reference for clinical practice.

Pancreatic neuroendocrine neoplasms (pNENs) is a category of highly heterogeneous tumors. Surgery is the only treatment option that offers the potential to cure pNENs. Neoadjuvant therapy enables patients with locally advanced pNENs or liver metastases to obtain the chance of reoperation. Neoadjuvant therapies for pNENs mainly include chemotherapy, targeted therapy, somatostatin analogues, and peptide receptor-radionuclide therapy, etc. CAPTEM regimen and platinum-based chemotherapy regimen are commonly used in chemotherapy. Somatostatin analogues and peptide receptor-radionuclide therapy are primarily given for individuals with high expression of somatostatin receptor. Targeted therapy is mainly delivered for locally advanced well-differentiated pNENs. These regimens can be adopted alone or combined to enhance clinical efficacy. At present, high-level evidence-based medicine evidence is lacking in the selection of treatment regimens, and systematic evaluation is also lacking in comparison of the clinical efficacy among different protocols.

Pancreatic acinar cell carcinoma (PACC) is a malignant epithelial tumor arising from pancreatic epithelium, which is rare in clinical practice due to low incidence, and it has no specific clinical manifestations. Previous studies have reported that PACC accounts for merely 1%-2% of exocrine pancreatic tumors and 0.44% of pancreatic malignant tumors. This disease is challenging to diagnose, has low resection rates, and easily metastasizes. However, the prognosis is better than that of pancreatic ductal adenocarcinoma. Understanding and mastering clinical diagnosis and treatment of PACC can improve diagnostic rate and clinical prognosis.

Autoimmune pancreatitis (AIP) is a special type of pancreatitis. Due to low clinical incidence and different epidemiological characteristics among regions, no consensus has been reached regarding the understanding of diagnosis and treatment of AIP. Due to lack of specific clinical symptoms, it is difficult to make an early diagnosis and the misdiagnosis rate is relatively high. In this article, based on recent guidelines on the diagnosis and treatment of AIP combined with clinical experience, research progress in the diagnosis and treatment of AIP was reviewed and analyzed, aiming to provide reference for improving the overall cure rate of AIP.

Splenomegaly is a common complication of portal hypertension and other diseases, leading to hypersplenism and coagulation abnormality, which will exert multiple effects on patients' health. At present, interventional therapy and surgery are the main treatment options for splenomegaly, among which splenectomy is the most effective procedure. In recent years, splenectomy is primarily performed under laparoscopy. Although multiple surgical approaches and perioperative management measures have been adopted to improve the safety of splenectomy, it is still likely to cause complications, such as abdominal bleeding and peripheral organ damage, etc. Interventional therapy followed by sequential surgery may be a favorable treatment option for splenomegaly patients complicated with severe hypersplenism.

Surgery has gradually evolved in the direction of minimally invasive procedure, and laparoscopic technique has also been gradually employed in surgery. Compared with other laparoscopic surgeries, laparoscopic pancreatic procedures are adopted relatively later due to the deep location of the pancreas, abundant blood supply and difficult exposure, etc. With the development of minimally invasive techniques, laparoscopic surgery has been widely applied in the surgical treatment of pancreatic diseases, which has evident advantages compared with open surgery. At present, tremendous progress has been made in the application of laparoscopy in pancreatic cancer, illustrating the minimally invasive advantages of laparoscopy in pancreatic cancer resection, staging and biopsy of pancreatic cancer and late palliative treatment. In addition, the safety and efficacy have also been preliminarily validated. In this article, research progress in the application of laparoscopy in pancreatic cancer was reviewed from the following perspectives.

Hepatobiliary diseases are common and severe diseases in clinical practice. Multiple hepatobiliary diseases are manifested with non-specific symptoms in the early stage, whereas with severe symptoms during the advanced stage, requiring surgical treatments. As a common examination method, ultrasonography has the characteristics of clear imaging, no irradiation, no trauma, high accuracy of positioning, convenience and low cost, etc. In recent years, multiple studies have been carried out in the application of ultrasonography in hepatobiliary surgery, and achieving novel progress and understanding. In this article, research progress in this aspect was reviewed, aiming to provide evidence for the application of ultrasonography in clinical hepatobiliary surgery.

Esophageal variceal bleeding, as the most common and severe complication of liver cirrhosis and portal hypertension, persistenly threatens the life and health of patients. Accurate evaluation of portal vein pressure provides valuable evidence for preventing disease progression, monitoring complications, choosing treatment strategies and evaluating clinical prognosis in patients with liver cirrhosis. At present, the hepatic venous pressure gradient (HVPG) remains the gold standard for the diagnosis of portal hypertension, whereas it is an invasive procedure with limitations and surgical risks. In recent years, certain progress has been made in non-invasive measurement of portal vein pressure. In this article, non-invasive detection method of portal vein pressure and its application prospect were illustrated.

Autoimmune pancreatitis (AIP) is a special type of pancreatitis, which primarily manifests as painless obstructive jaundice, mild abdominal pain or acute pancreatitis. In clinical practice, it is constantly misdiagnosed with pancreatic ductal adenocarcinoma (PDAC), whereas treatment and prognosis of these two conditions are completely different. Prior to surgery, it is difficult to make a definite differential diagnosis. In this article, the differences between them were illustrated from clinical manifestations, imaging, serological and histopathological characteristics, and relevant challenging problems were discussed accordingly.

With the development of laparoscopic techniques, laparoscopic pancreaticoduodenectomy has been widely applied. Reconstruction of the pancreatic stump is the challenging and key step of this procedure, which is directly associated with the occurrence of a series of complications, such as postoperative pancreatic fistula, etc. At present, multiple approaches have been employed to reconstruct pancreatic stump, whereas none of these procedures can completely avoid the incidence of pancreatic fistula. In this article, the development of pancreaticojejunostomy was reviewed, and the advantages and disadvantages of common pancreaticojejunostomy patterns were illustrated based on our surgical experience. Subsequently, a novel pancreaticojejunostomy pattern designed and employed by our team was introduced, namely, the end-to-side pancreaticojejunostomy with pancreatic binding and interlocking, and the future development of pancreaticojejunostomy were finally discussed. This study aims to help clinicians to be familiar with different patterns of pancreaticojejunostomy, and understand appropriate application scenarios of each approach, thereby assisting clinicians to make more appropriate surgical decisions, reduce the risk of postoperative complications and improve clinical prognosis of patients.

Intraoperative bleeding is a critical factor affecting clinical prognosis of patients after hepatectomy, and hepatic blood flow control technology is an effective method to minimize intraoperative bleeding. Different hepatic blood flow control technologies have their own advantages, disadvantages and indications. Hence, clinicians should fully understand, master and apply each technology in an individual manner. At present, surgeons' understanding of hepatic blood flow occlusion technology has been deepened in clinical practice, and specific methods and clinical applications have also been constantly improved and developed. In this article, progresses in hepatic blood flow control technologies, such as semi-hepatic inflow occlusion, total hepatic blood flow control, Glisson pedicle transection and portal vein balloon occlusion and so on, were reviewed.

Intraductal papillary neoplasm of the bile duct (IPNB) is a rare biliary neoplasm, which is characterized by intraductal papillary hyperplasia, complicated with biliary ductal system dilatation and possible intraductal mucus secretion. Clinical manifestations of IPNB are non-specific. According to different growth sites and grades of the neoplasm, it can be manifested as abdominal pain and obstructive jaundice. Patients complicated with biliary tract infection develop symptoms of acute cholangitis, such as fever and chills, etc. Blood test may indicate abnormal liver function and elevated bilirubin levels. Imaging examinations consist of abdominal ultrasound, plain or enhanced CT, MRI and endoscopic ultrasound, etc. Current imaging tools fail to make a highly-specific and effective differential diagnosis of IPNB before operation. At present, surgical resection is recommended as the optimal treatment. Surgical approaches include pancreaticoduodenectomy, choledochotomy + cholangiojejunostomy, radical resection of hilar cholangiocarcinoma + partial hepatectomy, etc. There is no definite evidence to prove the necessity of adjuvant chemoradiotherapy after surgical resection.

Biliary atresia is a category of disease caused by biliary cirrhosis due to progressive fibro-inflammatory obstruction of extrahepatic and intrahepatic bile ducts, and eventually progresses into liver failure. It is a common indication for liver transplantation in children. In this article, the pathogenesis, diagnosis of biliary atresia, timing, procedures and postoperative complications of liver transplantation were illustrated. Meantime, current status and development of pediatric liver transplantation were discussed.

The immune microenvironment of hepatocellular carcinoma (HCC) is mainly composed of tumor-associated macrophages, myeloid-derived suppressor cells and other cellular components, as well as extracellular components, such as cytokines, growth factors and extracellular matrix, etc. In China, most liver cancer patients are complicated with chronic hepatitis B and cirrhosis. Immune microenvironment promotes the incidence and progression of HCC, immune escape and treatment resistance, and exerts immunosuppressive effect. In recent years, significant progress has been made in immunotherapy for systemic treatment of HCC, such as immune checkpoint inhibitors (ICIs). However, in the KEYNOTE-240 and CheckMate 459 trials, anti-PD-1 therapy with nivolumab or pembrolizumab as a single drug failed to reach the expected overall survival endpoint. At present, it is urgent to deepen the understanding of immune microenvironment of HCC and explore novel therapies to improve clinical efficacy of ICIs. Currently, the combination of ICIs with other therapies (such as tyrosine kinase inhibitors, monoclonal antibodies or local therapy) has been proven to improve the efficiency of single ICIs. In this article, research progress in immune microenvironment, immunotherapy and immune combined with targeted therapy for HCC was reviewed.

Surgery has been considered as the most effective treatment for hepatocellular carcinoma (HCC). In spite of almost 100-year development, the survival benefits brought by surgery for HCC patients have not been further improved. In recent years, widespread application of targeted drugs and immune checkpoint inhibitors have provided a novel development direction for comprehensive treatment and related research of HCC. With widespread clinical application, the advantages of targeted immune therapy in the treatment of HCC at all stages are constantly presented, which make surgeons rethink whether the original concept of surgery for HCC is still correct. In this article, the problems and potential solutions in hepatectomy for HCC in the era of targeted immunotherapy were in-depth discussed.

Laparoscopic cholecystectomy (LC), as one of routine surgeries of general surgery, isa highly mature procedure. For experienced surgeons, conventional LC is not a demanding procedure. However, bile duct injury cannot be completely avoided. As a novel procedure, ICG fluorescence navigation LC, different from traditional critical view of safety and intraoperative cholangiography and alternative safety measures, can better identify the structures of biliary system and thus lower the incidence of iatrogenic injury of biliary tract. In this article, based on relevant literature review at home and abroad and clinical experience of our team, the differential researches of ICG fluorescence navigation LC were analyzed, aiming to provide reference for mature development of this procedure in the future.