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The tumor microenvironment of pancreatic ductal adenocarcinoma (PDAC) is non-immunogenic, which consists of the stellate cells, fibroblasts, immune cells, extracellular matrix, and some other immune suppressive molecules. This low tumor perfusion microenvironment with physical dense fibrotic stroma shields PDAC from traditional antitumor therapies like chemotherapy and various strategies that have been proven successful in other types of cancer. Immunotherapy has the potential to treat minimal and residual diseases and prevent recurrence with minimal toxicity, and studies in patients with metastatic and nonresectable disease have shown some efficacy. In this review, we highlighted the main components of the pancreatic tumor microenvironment, and meanwhile, summarized the advances of some promising immunotherapies for PDAC, including checkpoint inhibitors, chimeric antigen receptors T cells, and cancer vaccines. Based on our previous researches, we specifically discussed how granulocyte-macrophage colony stimulating factor based pancreatic cancer vaccine prime the pancreatic tumor microenvironment, and introduced some novel immunoadjuvants, like the stimulator of interferon genes. Keywords: Pancreatic ductal adenocarcinoma, Tumor microenvironment, Immunotherapy, Cancer vaccine, Stimulator of interferon genes

The effects of laparoscopic liver resection (LLR) and open liver resection (OLR) on oncological outcomes for colorectal cancer liver metastases (CCLM) remain inconclusive. Major databases were searched from January 1992 to October 2016. Effects of LLR vs OLR were determined. The primary endpoints were oncological outcomes. In total, 32 eligible non-randomized studies with 4697 patients (LLR: 1809, OLR: 2888) were analyzed. There were higher rates of clear surgical margins (OR: 1.64, 95%CI: 1.32 to 2.05, p P P , P p p

To investigate the effect of Chaiqin Chengqi Decoction (柴芩承气汤, CQCQD) on regulating serum matrix metalloproteinase 9 (MMP-9) in patients with severe acute pancreatitis (SAP). Thirty-five SAP patients hospitalized in West China Hospital from September 1, 2008 to February 28, 2009 were randomly assigned to two groups using a computer-derived random number sequence in a ratio of 1:1, treatment group (18 patients) and the placebo control group (17 patients). The patients in the treatment group were administered with CQCQD by gastric perfusion (50 mL/2 h) and retention enema (200 mL/6 h) for 7 days. The two groups had similar baseline information. The clinical indicators, including the initial Balthazar’s computed tomography (CT) score, acute physiology and chronic health evaluation II (APACHE II) scores on 1st, 3rd, 5th and 7th day, incidences and durations of complications and the serum C-reactive protein (CRP), levels of MMP-9 on the 1st, 3rd, 5th and 7th day, were recorded and compared between the two groups. The serum MMP-9, CRP and the APACHE II scores on the 3rd, 5th and 7th day in the treatment group were lower than those in the control group (P

Background/Aims To investigate the beneficial effect of N-Acetylcysteine (NAC) on pancreatic microvascular perfusion in acute necrotizing pancreatitis (ANP). Methods Fifty-four rats were divided into a control group, an ANP group and an NAC-treated group. The ANP model was established by a retrograde injection of 3% sodium taurocholate into the pancreatic duct. The NAC-treated group received an intravenous infusion of NAC just 2 hours before and 30 minutes after the induction of ANP. The pancreatic microvascular perfusion was measured with laser Doppler flowmetry and pancreatic samples were collected for histological examination. Results The microvascular perfusion in the NAC-treated group decreased slightly and exhibited a significant increase compared to the ANP group (p

BACKGROUND/AIMS To study the ability of matrix metalloproteinase-9 (MMP-9) to predict pancreatic necrosis (PN) in patients with severe acute pancreatitis (SAP). METHODOLOGY From July 1, 2010 to December 31, 2010 patients diagnosed with SAP were included (n=35). Serum MMP-9, CRP and IL-6 were analyzed on days 1, 3, 5 and 7 of hospitalization to determine if they could predict the development of pancreatic necrosis. RESULTS Of the 35 patients included, 12 (34.3%) had evidence of PN. Admission MMP-9 concentrations were significantly higher in patients with PN compared to subjects without PN (13.1±4.0 vs. 7.5±3.8, p

Pancreatic panniculitis is a rare type of disorder associated with pancreatic diseases. We describe here a case of 54-year-old man who was admitted to the Department of Dermatology with the diagnosis of erythema nodosum. The patient presented with a 9-month history of painful erythematous nodules on the extremities, joint pain and swelling, and weight loss. A highly elevated level of pancreatic lipase was found on the laboratory examinations. The biopsy specimens from the skin lesions showed subcutaneous fat necrosis. Abdominal computed tomography (CT) revealed a large mass with central necrosis in the body and tail of the pancreas. Distal pancreatectomy, splenectomy and partial transverse colectomy were successfully performed on day 17 of the hospitalization. The histopathologic findings supported the diagnosis of acinar cell carcinoma of the pancreas (ACCP). Postoperatively, the level of serum lipase returned to normal, and the skin lesions and joint manifestations gradually regressed. However, the swelling did not significantly resolve in the left knee. In view of the non-specific clinical presentation of this disease, clinicians should be alert and have a high index of suspicion for pancreatic panniculitis.

Pancreatic tuberculosis (TB) is extremely rare and mimics pancreatic carcinoma both clinically and radiologically. This paper discusses the occurrence of 2 heterogeneous masses located in the head and tail of the pancreas in an adult male. In this patient, laparotomy was performed because of the high suspicion of pancreatic carcinoma. Intraoperative fine needle aspiration biopsy revealed the coexistence of pancreatic carcinoma with pancreatic TB, and a combined resection of the distal pancreas and spleen was successfully performed. Following surgery, the patient received standard chemotherapy for TB. At 7-month follow-up, computed tomography showed resolution of the mass in the pancreatic head. Clinicians must maintain a high index of suspicion for pancreatic TB in patients with pancreatic masses. The coexistence of malignancy and TB should be considered when patients present with multiple pancreatic masses.