In order to further standardize the prevention and treatment of postoperative complications of pancreatic surgery, the editorial board of the Chinese Journal of Surgery organized relevant experts to formulate this guideline under the promotion of the Study Group of Pancreatic Surgery in China Society of Surgery of Chinese Medical Association and Pancreatic Disease Committee of China Research Hospital Association. According to the grading of recommendations assessment, development, and evaluation system, this guide discusses the hot issues on postoperative complications such as pancreatic fistula, biliary fistula, chylous fistula, post-pancreatectomy hemorrhage, abdominal infection, delayed gastric emptying, etc., quantitatively evaluates the level of evidence in clinical studies, and forms recommendations after repeatedly consulting. It is hoped to provide reference for pancreatic surgeons in the prevention and treatment of postoperative complications.
为了进一步规范我国胰腺外科术后并发症的防治，在中华医学会外科学分会胰腺外科学组、中国研究型医院学会胰腺疾病专业委员会的推动下，《中华外科杂志》编辑部组织相关专家制定本指南。本指南基于推荐意见分级的评估、制定及评价系统，围绕胰瘘、胆瘘、乳糜瘘、术后出血、腹腔感染、胃排空延迟等术后并发症的热点问题展开讨论，对现有临床研究的证据等级进行量化评估，并经相关专家多次讨论修改后，形成推荐意见，以期规范我国外科医师针对胰腺术后并发症的围手术期处理，提高防治水平。.

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The aim was to evaluate the various operative techniques and outcomes used to manage the pancreatic transection plane (or stump) during a left (distal) pancreatectomy and to develop expert consensus guidelines.
Evidence-based, clinically relevant questions were discussed and then were circulated among members of the International Study Group of Pancreatic Surgery. After agreement on the questions and statements, voting in a 9-point Likert scale was used to gauge the level of objective support for each.
Studies using the International Study Group of Pancreatic Surgery definition of postoperative pancreatic fistula including 16 randomized trials were reviewed to generate a series of statements set into 14 domains. There was strong consensus in the following statements: there was no difference in the postoperative pancreatic fistula rate after left pancreatectomy between the handsewn and stapler techniques; a stapling technique could not be used in all cases of left pancreatectomy; the use of an energy-based tissue sealant or a chemical sealant device or combinations of these did not impact the postoperative pancreatic fistula rate; there was no difference in the postoperative pancreatic fistula rate between the open, laparoscopic, or robotic approaches; and there are 1 or more clinically important, patient-related risk factors associated with the postoperative pancreatic fistula rate. There was weak or conditional agreement on the use of prophylactic somatostatin analogs, stents, stump closure, stump anastomosis, and the role of abdominal drains.
Areas of strong consensus suggests a change in clinical practice and priority setting. Eight domains with lower agreement will require novel approaches and large multicenter studies to determine future key areas of practice.

In 2017, following many thorough discussions, considering Chinese actual situation, more than 20 distinguished pancreatic surgeons brought about an update of the previous 2010 Chinese experts\' consensus on the prevention and treatment of common complications after pancreatic surgery. Referred to the latest update of the postoperative pancreatic fistula consensus statement by the International Study Group of Pancreatic Surgery, the postoperative pancreatic fistula system of 2017 version Chinese consensus divided pancreatic fistula into pure fistula and mixed fistula based on whether other digestive fluid is mixed or not. The new version also presents key points of pancreatic fistula prevention and surgical strategy. In the paper, the authors analyzed the necessity, essentials and controversy of the update.
2017年，国内20余名胰腺外科专家经过多次讨论，结合我国实际情况对2010版《胰腺术后外科常见并发症的预防及治疗的专家共识》进行了更新和发布，其中胰瘘章节参考了国际胰瘘研究小组2016版的术后胰瘘定义和分级系统，根据是否混有其他消化液，将胰瘘分为单纯瘘和混合瘘，并提出了胰瘘的预防要点和手术治疗策略。本文主要对2017版共识更新的必要性、更新的要点与存在的争议进行解读。.

Based on the latest update of the consensus statement by the International Study Group of Pancreatic Surgery, combined with China\'s actual situation, an update of the previous 2010 consensus on the Chinese experts of the prevention and treatment of common complications after pancreatic surgery was developed, with more than 20 extinguished experts to participate in, following many thorough discussions.This statement included pancreatic fistula, biliary fistula, postoperative bleeding, intraperitoneal infection and gastric emptying delay, and a new chapter of chyle leak. Each chapter is defined in terms of definition, grade, classification, prevention and treatment. In the end, the long-term postoperative complications of pancreatic surgery were emphasized, and the application of Clavien-Dindo classification in the evaluation of postoperative complications of pancreatic surgery was highly-recommended.
本版共识在参考国际胰腺病研究组新发布的专家共识的基础上，由国内20余名专家参与，历经3次讨论，结合我国实际情况，对2010版国内专家共识进行了更新。内容包括胰瘘、胆瘘、术后出血、腹腔感染和胃排空延迟，并新增乳糜瘘章节，每章节按照定义、分级、分类、预防及治疗进行阐述。最后强调了胰腺术后的远期并发症，并建议将Clavien－Dindo分级系统引入胰腺术后并发症的评估。.

OBJECTIVE: Solid pseudopapillary tumor (SPT) of the pancreas is a rare neoplasm, its preoperative diagnosis is difficult and therefore inappropriate therapy or postoperative complications are frequent. Reviewing the literature, the purpose of this article was to identify guidelines to improve diagnosis and treatment of SPT.
METHODS: Authors report a case of SPT of the pancreas in a 27-year-old woman in whom a mistaken radiologic diagnosis made surgical strategy difficult and caused postoperative complications.
CONCLUSIONS: Clinicians and surgeons should: (1) consider the possible disease of SPT in young females, with pancreatic encapsulated lesion with well-defined borders and variable central areas of cystic degeneration, necrosis or hemorrhage showed on radiological examinations. (2) Intensity of the differentiation of the clinical symptoms, especially during the course of therapy of chronic gastritis and diabetes. (3) Use immunohistochemical stains of alpha-1-antitrypsin, alpha-1-antichymotrypsin, vimentin and neuron-specific enolase. (4) Keep this unusual but potentially curable tumor in mind, following patients who had suffered from acute pancreatitis or abdominal injury. Increasing experience with this tumor leads to a greater awareness of its clinical presentation and pathological features and a lower rate of misdiagnosis. (5) Finally, perform, where technically feasible, conservative surgical treatment, that is safe and effective.

OBJECTIVE: Pancreaticoduodenectomy (PD) is still associated with high morbidity. To reduce the frequency of postoperative complications, we have made revisions in perioperative managements of pancreaticoduodenectomy.
METHODS: Subjects were 128 consecutive patients who underwent PD between January 2000 and August 2006. In June 2004, the following new departmental guidelines were introduced: (1) modified Kakita method of pancreaticojejunostomy, (2) omental wrapping, (3) early removal of closed-suction drain, and (4) restrictive use of pancreatic and biliary duct stenting. Operative mortality and morbidity between 77 patients managed conventionally (group A) and 51 patients since 2004 (group B) were compared. Risk factors for postoperative complications were determined.
RESULTS: Postoperative morbidity in group B (39%) was significantly lower than in group A (64%; P = 0.019). Occurrence of grade B/C pancreatic fistula (PF) in group B (6%) was significantly lower than in group A (19%; P = 0.0376). Delayed gastric emptying was significantly reduced in group B relative to group A (23% vs 6%; P = 0.0133). Logistic regression analyses showed that the modified Kakita method was a negative independent factor for overall complications, PF, and delayed gastric emptying.
CONCLUSIONS: The incidence of overall postoperative complications, grade B/C PF, and delayed gastric emptying after PD has been reduced because of the introduction of a new guideline.

OBJECTIVE: Diagnosis of pancreatic trauma and its complications may be difficult due to non-specific signs and symptoms and treatment recommendations are not unequivocal.
METHODS: Clinical data of a series of 47 patients with pancreatic trauma were analyzed; most of them were polytraumatized and treated by an interdisciplinary team.
RESULTS: The most common causes were traffic accidents and sport injuries with 66% and 15%, respectively. Concomitant injuries were seen in 96% (nonpancreatic intra-abdominal injuries 85% including spleen 38% and liver 34%, extra-abdominal injuries 70%). Concomitant liver injuries were treated conservatively in 31% and operatively in 69% (including hepatic packing in 38%). Concomitant splenic injuries were usually very severe and could be managed conservatively in only 11%. All patients with pancreatic injuries grade III, IV or V (17%) according to the American Association of Surgical Trauma Classification required surgery, endoscopic treatment or interventional radiology. The most common posttraumatic complications were necrotizing pancreatitis (15%), pseudocyst formation (9%), abscesses (6%) and fistulas (4%).
CONCLUSIONS: The status of the pancreatic duct is the crucial point for management of pancreatic trauma and should be assessed as early as possible. Treatment has to be tailored to the individual situation, especially in patients with severe concomitant injuries or prolonged course.