Pancreatic cancer is one of the most malignant solid tumors. For pancreatic cancer that cannot be surgically resected, transarterial infusion chemotherapy can achieve better therapeutic effects due to higher local drug concentration in the tumor than intravenous drugs, and has achieved remarkable results in improving disease-related symptoms, prolonging survival, reducing liver metastases and treating liver metastases after they occur. This guideline gives more detailed and standardized recommendations on relevant concepts, contraindications, indications, preoperative preparation, operation methods, postoperative management and prevention and management of complications, aiming to help domestic colleagues make reasonable decisions, but it is not a mandatory standard and cannot include and solve all problems in transarterial perfusion chemotherapy for pancreatic cancer. Therefore, when faced with a particular patient, a reasonable treatment plan should be developed for the patient based on a full understanding of the best medical evidence of the disease, combined with the patient’s specific condition and his or her wishes. 1. Overview Pancreatic cancer is one of the most malignant solid tumors, with a mortality to morbidity ratio of 0.99:1. Statistics from Beijing and Shanghai before 2006 show that its incidence rate is in the 9th place of malignant tumors and mortality rate is in the 6th place. The cause of pancreatic cancer is unknown and is related to genetic factors, high fat diet, intake of high animal protein, smoking, alcoholism, chronic pancreatitis, diabetes, excessive coffee consumption, and surgical resection of the stomach. More than 2/3 of pancreatic cancer occurs in the head of the pancreas, about 1/4 occurs in the tail of the pancreatic body, and 1/10 in the whole pancreas. pancreatic cancer often has no obvious symptoms in the early stage, and when it is detected, it is already in the advanced stage, and the opportunity of surgical resection is lost. The tumor stage and KPS score are independent factors affecting the prognosis of pancreatic cancer. For pancreatic cancer that cannot be surgically resected, palliative treatment can be used. Studies have proved that transarterial infusion chemotherapy can achieve better therapeutic effects due to higher local drug concentration in the tumor than intravenous drugs, and has achieved impressive results in improving disease-related symptoms, prolonging survival, reducing liver metastasis and treatment after liver metastasis occurs. In the advanced stage of pancreatic head cancer, it may compress or invade the common bile duct and cause obstructive jaundice, and interventional treatment for obstructive jaundice is feasible at this time. 2. Indications and contraindications 2.1 Indications: locally advanced pancreatic cancer that cannot be surgically resected; pancreatic cancer that has lost the chance of surgery due to medical reasons; pancreatic cancer with liver metastasis. Contraindications (1) Contraindication to the use of angiography and contrast agents. (2) Large amount of ascites and multiple metastases throughout the body. (3) Systemic failure, obvious malignancy, ECOG score >2, with multiple organ failure. (4) Those with bleeding or coagulopathy that cannot be corrected, with significant bleeding tendency. (5) Patients with poor liver and kidney function, exceeding 3 times the normal reference value. (6) White blood cells <3.5×109/L and platelets <50×109/L. The above (1) to (3) are absolute contraindications and (4) to (6) are relative contraindications. 3. Preoperative preparation (1) Patient preparation Skin preparation at the puncture site, fasting food and water for 4 hours before surgery. (2) Laboratory examination Routine check of tumor markers (CA199, CEA, CA125, etc.), blood routine, liver and kidney function, coagulation system, electrolytes, electrocardiogram, frontal and lateral chest, etc., to understand the patient's systemic and major organ condition, to decide whether there are contraindications to treatment, and to facilitate postoperative observation and comparison. (3) Imaging examinations For the first treatment and without pathological diagnosis, two or more imaging examinations must indicate the imaging characteristics of pancreatic cancer, and the scan should include all of the pancreas. (4) Pre-operative medication Anti-emetic drugs should be given intravenously half an hour before perfusion chemotherapy, and no special treatment is required. (5) Sign the informed consent form before surgery (6) Medication method: If high-dose cisplatin (>100mg/time) is used for infusion chemotherapy, the possible nephrotoxicity should be rescued before infusion of cisplatin, usually saline or glucose solution 1000ml plus 15% potassium chloride 10ml intravenously 6 hours before arterial infusion chemotherapy; 20% mannitol 125ml intravenously is given once before treatment. ml intravenous drip before treatment, postoperative hydration. (7) Instrument preparation Including puncture needle, super-slip guidewire, catheter sheath, catheter, chemotherapy drug box (used for subcutaneous chemotherapy drug box placement). 4.Operation method (1) Patient position The patient is in the supine position. (2) Operation steps Routine inguinal disinfection and towel laying, local anesthesia in the groin, modified selding method of puncturing the femoral artery, placing the arterial sheath, and selective arterial cannulation. After removal of the catheter and arterial sheath, local compression was applied to stop bleeding. The interventional treatment of patients with obstructive jaundice refers to the guidelines for interventional treatment of malignant obstructive jaundice. (3) Drug selection Gemcitabine, fluorouracil, tetrahydrofolic acid, cisplatin, oxaliplatin, etc. can be used. (4) Drug administration can be intraoperative one time shock infusion chemotherapy, or sustainable infusion chemotherapy. ① Antibiotic treatment if necessary; ② Adequate rehydration, liver protection, symptomatic treatment (antiemetic, antipyretic, etc.) for 3-5 days; ③ Review of liver and kidney function, blood routine, tumor markers, serum amylase, etc. within 1 week after surgery. Common complications (1) Complications related to endovascular operation Hematoma, arterial entrapment, arterial spasm, occlusion, etc. (2) Complications related to chemotherapy drugs: nausea, vomiting, pain, fever, bone marrow suppression, liver function damage, kidney function damage, etc. 7.Efficacy evaluation and follow-up requirements Monthly follow-up is recommended for quality of life evaluation (QOL, ECOG scoring system is recommended) and routine blood, liver and kidney function, tumor markers and imaging.