Oncology Frontier:Duodenopancreatectomy is the basic treatment for patients with pancreatic cancer or periampullary cancer. What is the difference in postoperative complications， peri-operative mortality， and the disease free survival between pylorus-preserving pancreatic duodenal resection and standard Whipple’s surgical?

　　《肿瘤瞭望》：对胰头癌或是壶腹周围癌的患者，胰十二指肠切除术是基本的治疗方式，保留幽门的胰十二指肠切除术和标准的Whipple’s术式 在术后并发症、手术死亡率及术后无疾病进展生存上有何差异 ？

　　Dr Terashima: Because patients undergoing pancreaticoduodenectomy for gastric cancer have very advanced disease， more extensive surgery is required including extended lymphadenectomy around the para-aortic area. Sometimes a total gastrectomy is required. That is the why the incidence of post-operative complications is so high. Disease-free survival is also not very good compared to pancreatic cancer because the patient having pancreaticoduodenectomy for gastric cancer has more advanced disease.

　　Dr Terashima：由于进行胰十二指肠切除术的胃癌患者的疾病处于非常晚期阶段，所以他们需要范围相对较广泛的手术，包括腹主动脉旁淋巴结清扫，有时还需要进行全胃切除术。这就是为什么术后并发症会很高的原因。相比于胰腺癌患者，需进行胰十二指肠切除术的非常晚期的胃癌患者的无病生存也不是很好。

　　Oncology Frontier: Some common postoperative complications exist after pancreaticduodenaectomy， such as pancreatic fistula and fistula formation. Is there a model of risk score to predict the incidence of postoperative anastomotic leak in patients with pancreatic or periampullary cancer?

　　《肿瘤瞭望》：胰十二指肠切除术后存在一些常见的并发症，如胰腺吻合口瘘和瘘管形成，有没有一种术前的评估风险模型可以预测胰头癌或是壶腹周围癌患者术后的胰腺吻合口瘘的发生率？

　　Dr Terashima: For pancreatic cancer and bile duct cancer， there are some models for predicting post-operative complications. However， in gastric cancer， the numbers of patients are quite low so we cannot accurately determine risk for complications.

　　Dr Terashima：对于胰腺癌和胆管癌，已经有一些模型可以预测术后并发症的发生率。但是由于胃癌患者数目太少，我们还没有办法通过模型准确地预测并发症的风险。

　　Oncology Frontier: Pancreatic anastomosis leakage is a common complication after pancreaticoduodenectomy and it’s difficult to deal with. What would you recommend for the management of pancreatic anastomosis leakage?

　　《肿瘤瞭望》： 胰十二指肠切除术后胰腺漏液是常见的难治并发症，你们中心是怎么处理这种并发症的？

　　Dr Terashima: In gastric cancer， the pancreatic duct is very narrow compared to pancreatic cancer where the duct will actually be enlarged. That makes it easy to anastomose. But in gastric cancer， there is no pancreatic duct stenosis so the duct remains very narrow making it difficult to anastomose. The way to approach this is implant a tube into the pancreatic duct. This is not commonly done in pancreatic cancer， but is a useful strategy in gastric cancer. Drainage is most important. There is no effective medical treatment or drug for preventing pancreatic leakage.

　　Dr Terashima：相比于较好吻合的导管扩张的胰腺癌患者，胃癌的胰腺导管就相对狭窄。在胃癌患者的手术中，由于导管狭窄所以很难吻合，解决的方法就是在胰腺导管中放入一个胶管。这个方法在胰腺癌手术中很少用，但是在胃癌手术中却很实用。 没有很有效的药物或手段来预防胰腺漏液，引流是最重要的处理方法。

　　Oncology Frontier: Is there anything you would like to share with the Chinese medical community?

　　《肿瘤瞭望》：您还有什么信息想要与中国医学同道分享吗？

　　Dr Terashima: As I mentioned in my presentation， this type of procedure is highly invasive， so for the future we need to work on neoadjuvant chemotherapy strategies to reduce the need for pancreaticoduodenectomy.

　　Dr Terashima：正如我在报告中提到的，这种手术方法具有高度创伤性，所以我们未来需要进一步改善新辅助放化疗方案，以减少胰十二指肠切除术的需要。