Complete mesocolic excision for colonic cancer : Society for Translational Medicine expert consensus statement

Total mesorectal excision (TME), a revolutionary change and a milestone in the history of surgical treatment for rectal cancer, has been widely recognized as the gold standard and is now a routine procedure. The concept of complete mesocolic excision (CME) was proposed based on the similar philosophy as TME, aimed to achieve better surgical quality and improve the oncological outcomes of colon cancer. In recent years, many surgeons have increasingly adopted the principle and conducted clinical trials to verify the effect of CME; however, whether CME should be used as the standard surgical technique is still controversial. In this article, we reviewed and updated the literature. Experts in this field from nine countries were invited to complete a questionnaire concerning CME, with the aim to illustrate the embryological and anatomical basis and reach a consensus of the current situation and future of CME

Ранняя диагностика хронического панкреатита

Chronic pancreatitis is one of the most challenging disorders from the perspective of its early diagnosis and effective treatment. Within the last decade, the diagnosis of early chronic pancreatitis has been firmly introduced into the practice of gastroenterology. The delineation of this form as an initial stage of chronic pancreatitis is based on the need in early and effective treatment that could cease the progression of the disease and reduce the possibility of its complications. The diagnostic criteria of chronic pancreatitis have been described in details in the literature; however, specifics of the diagnosis in its early stage have been scarcely highlighted. Chronic pancreatitis is commonly diagnosed with a number of imaging techniques (they can show abnormalities in morphology of the pancreas), as well as laboratory tests (showing functional organ deficit). However, morphological and imaging techniques are insufficient for the diagnosis of the early chronic pancreatitis. A new integral strategy towards early diagnosis seems necessary, that would consider not only the morphology, but also potential etiology, risk factors of the disease and its complications in patients with suspected chronic pancreatitis. The review of the literature presents the definition of the early pancreatitis and discusses the potential of imaging techniques and functional tests in its diagnosis. An adequate strategy for the diagnosis of the early pancreatitis is formulated, based on an individual patient characteristic with suspected early chronic pancreatitis, namely, risk factors, clinical manifestations, imaging results and serological biomarkers.Хронический панкреатит одно из наиболее сложных заболеваний с точки зрения проведения ранней диагностики и эффективного лечения. В течение последнего десятилетия диагноз ранний хронический панкреатит прочно входит в гастроэнтерологическую практику. Выделение данной формы как начальной стадии развития хронического панкреатита обусловлено необходимостью проведения раннего и эффективного лечения, что позволяет остановить прогрессирование заболевания и снизить вероятность его осложнений. Критерии диагностики хронического панкреатита подробно описаны в научной литературе, тем не менее особенности распознавания его ранней формы освещены скупо. Хронический панкреатит обычно диагностируют с помощью ряда методов визуализации (они могут обнаружить морфологические изменения в поджелудочной железе), а также лабораторных тестов (определяют функциональную недостаточность органа). Однако для диагностики раннего хронического панкреатита использования исключительно морфологических и визуализационных методов недостаточно. Необходимым представляется новый интегральный подход к ранней диагностике, учитывающий не только морфологию, но также возможную этиологию, факторы риска развития заболевания и его осложнений у пациентов с подозрением на хронический панкреатит. В обзоре литературы дано определение раннего панкреатита, обсуждаются возможности методов визуализации, функциональных тестов в диагностике раннего хронического панкреатита. Формулируется адекватный подход к диагностике раннего хронического панкреатита, диагноз при котором опирается на комплекс индивидуальных особенностей пациента с подозрением на ранний хронический панкреатит, а именно факторы риска, клинические проявления, результаты визуализации и серологические биомаркеры

Russian consensus on exo-and endocrine pancreatic insufficiency after surgical treatment

The Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian Pancreatic Club using the Delphi method. Its goal was to consolidate the opinions of national experts on the most relevant issues of diagnosis and treatment of exo- and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is ensured by the participation of leading gastroenterologists and surgeons

The Miami International Evidence-based Guidelines on Minimally Invasive Pancreas Resection.

The aim of this study was to develop and externally validate the first evidence-based guidelines on minimally invasive pancreas resection (MIPR) before and during the International Evidence-based Guidelines on Minimally Invasive Pancreas Resection (IG-MIPR) meeting in Miami (March 2019). MIPR has seen rapid development in the past decade. Promising outcomes have been reported by early adopters from high-volume centers. Subsequently, multicenter series as well as randomized controlled trials were reported; however, guidelines for clinical practice were lacking. The Scottisch Intercollegiate Guidelines Network (SIGN) methodology was used, incorporating these 4 items: systematic reviews using PubMed, Embase, and Cochrane databases to answer clinical questions, whenever possible in PICO style, the GRADE approach for assessment of the quality of evidence, the Delphi method for establishing consensus on the developed recommendations, and the AGREE-II instrument for the assessment of guideline quality and external validation. The current guidelines are cosponsored by the International Hepato-Pancreato-Biliary Association, the Americas Hepato-Pancreato-Biliary Association, the Asian-Pacific Hepato-Pancreato-Biliary Association, the European-African Hepato-Pancreato-Biliary Association, the European Association for Endoscopic Surgery, Pancreas Club, the Society of American Gastrointestinal and Endoscopic Surgery, the Society for Surgery of the Alimentary Tract, and the Society of Surgical Oncology. After screening 16,069 titles, 694 studies were reviewed, and 291 were included. The final 28 recommendations covered 6 topics; laparoscopic and robotic distal pancreatectomy, central pancreatectomy, pancreatoduodenectomy, as well as patient selection, training, learning curve, and minimal annual center volume required to obtain optimal outcomes and patient safety. The IG-MIPR using SIGN methodology give guidance to surgeons, hospital administrators, patients, and medical societies on the use and outcome of MIPR as well as the approach to be taken regarding this challenging type of surgery