“可能切除的”胰腺癌的外科治疗策略

马永蔌; 杨尹默

“可能切除的”胰腺癌的外科治疗策略

北京大学第一医院普外科

详细信息

中图分类号: R735.9
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出版历程
- 收稿日期: 2011-10-11
- 出版日期: 2011-11-20

Surgical therapy strategies of borderline resectable pancreatic cancer

摘要

摘要: "可能切除的"胰腺癌介于"可切除"与"不可切除"之间,其定义的主要内涵是肠系膜上静脉、门静脉、肠系膜上动脉或肝总动脉是否为肿瘤侵犯及是否可切除重建,是目前的热点课题。"可能切除的"胰腺癌所涉及的外科相关问题包括:联合血管切除的安全性、有效性;淋巴清扫范围;标本切缘检测的标准化等。治疗方面建议对此类患者行新辅助放化疗,以增加R0切除的几率及可能性,但具体方案尚不统一,亦无RCT研究佐证。在目前多学科治疗模式及理念下,R1切除的价值及意义值得重新审视。
- 胰腺肿瘤
Abstract: The "borderline resectable" pancreatic cancer is a distinct subset which blurs the distinction between resectable and locally advanced disease.Patients with borderline resectable pancreatic cancer include those whose tumors have invaded either superior mesenteric vein, portal vein, common hepatic artery or superior mesenteric artery, but are still amenable to resection and reconstruction.The issues of surgical treatment for borderline resectable pancreatic cancer are as follows: the safety and efficacy of vascular resection and reconstruction, the boundary of extended lymphadenectomy, and the standardized examination of resection margin.A preoperative chemotherapy is recommended for these patients to maximize the potential for an R0 resection, despite the fact there is still no standard chemotherapy regimen or RCT research evidences.Under the current concept of multidisciplinary treatment for this disease, the clinical value of an R1 resection for the borderline resectable pancreatic cancer should be reconsidered.
- pancreatic neoplasms

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参考文献(11)

[1] Jemal A, Siegel R, Xu J, et al. Cancer statistics, 2010[J]. CA Cancer J Clin, 2010, 60 (5) : 277-300.

[2]National Comprehensive Cancer Network (NCCN) Clinical Prac-tice Guidelines in Oncology for Pancreatic Adenocarcinoma V.2.2011.

[3]Yekebas EF, Bogoevski D, Cataldegirmen G, et al.En blocvascular resection for locally advanced pancreatic malignan-cies infiltrating major blood vessels:perioperative outcomeand long-term survival in 136 patient[J].Ann Surg, 2008, 247 (2) :300-309.

[4]Slidell MB, Chang DC, Cameron JL, et al.Impact of totallymph node count and lymph node ratio on staging and sur-vival after pancreatectomy for pancreatic adenocarcinoma:alarge, population-based analysis[J].Ann Surg Oncol, 2008, 15 (1) :165-174.

[5]Raut CP, Tseng JF, Sun CC, et al.Impact of resection sta-tus on pattern of failure and survival after pancreaticoduode-nectomy for pancreatic adenocarcinoma[J].Ann Surg, 2007, 246 (1) :52-60.

[6]Butturini G, Stocken DD, Wente MN, et al.Influence of re-section margins and treatment on survival in patients withpancreatic cancer:meta-analysis of randomized controlledtrials[J].Arch Surg, 2008, 143 (1) :75-83.

[7]Doi R, Imamura M, Hosotani R, et al.Surgery versus radio-chemotherapy for resectable locally invasive pancreatic canc-er:Final results of a randomized multi-institutional trial[J].Surg Today, 2008, 38 (11) :1021-1028.

[8] Esposito I, Kleeff J, Bergmann F, et al. Most pancreatic cancer resections are R1 resections[J]. Ann Surg Oncol, 2008, 15 (6) : 1651-1660.

[9]Katz MHG, Pisters PWT, Evans DB, et al.Borderline resect-able pancreatic cancer:the importance of this emergingstage of disease[J].J Am Coll Surg, 2008, 206 (5) :833-848.

[10] Glocher H, Brunner T, Grabenbauer G, et al. Preoperative chemoradiation in adenocarcinoma of the pancreas. A single centre experience advocating a new treatment strategy [J]. Eur J Surg Onco, 2008, 34 (7) : 756-764.

[11]Gillen S, Schuster T, Meyer Zum Buschenfelde C, et al.Preop-erative/neoadjuvant therapy in pancreatic cancer:A systematicreview and meta-analysis of response and resection percenta-ges[J].PLoS Med, 2010, 7 (4) :e1000267.

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