Fischer L, Friess H, Z'graggen K, Uhl W, Büchler M W
Chirurgische Universitätsklinik Heidelberg.
Zentralbl Chir. 2003 May;128(5):390-5. doi: 10.1055/s-2003-40033.
The carcinoma of the pancreas is one of the 10 leading causes of death in the Western countries. Because of the resistance of pancreatic cancer against radiation and/or chemotherapy surgery is still the only possibility for cure. However, about 80 % of patients with the diagnosis of pancreatic cancer are no more suitable for curative resection at the time of diagnosis because of local tumor infiltration or the presence of distant metastases. This is one reason for the unsatisfactory situation in terms of 5-year-survival rate of 3 to 24 %. In resectable tumors of the pancreas head the standard Whipple dominates still as the surgical method of choice. However, the pylorus preserving Whipple has been established as a surgical alternative to the classical Whipple. Other surgical procedures like extended or regional pancreatic resections, predominantly done by Japanese surgeons seem to fit the concept of radical resection. But compared to the classical Whipple or the pylorus preserving Whipple resection there is still no clear advantage in terms of long term survival. The prospective European multicenter study ESPAC-1 firstly demonstrated a survival advantage for adjuvant chemotherapy (5-FU and folic acid) but no gain for radiochemotherapy in the treatment of patients with R0 or R1 resected pancreatic cancer in terms of prolongation of mean survival (19.7 months vs. 14.0 months).
胰腺癌是西方国家十大主要死因之一。由于胰腺癌对放疗和/或化疗具有抗性，手术仍是唯一可能治愈的方法。然而，约80%的胰腺癌患者在确诊时因局部肿瘤浸润或存在远处转移而不再适合进行根治性切除。这就是5年生存率仅为3%至24%，情况不尽人意的原因之一。在可切除的胰头肿瘤中，标准的惠普尔手术仍然是首选的手术方法。然而，保留幽门的惠普尔手术已成为经典惠普尔手术的替代术式。其他手术方式，如扩大或区域性胰腺切除术，主要由日本外科医生实施，似乎符合根治性切除的理念。但与经典惠普尔手术或保留幽门的惠普尔切除术相比，在长期生存方面仍没有明显优势。欧洲前瞻性多中心研究ESPAC-1首次证明，辅助化疗（5-氟尿嘧啶和叶酸）对R0或R1切除的胰腺癌患者的治疗有生存优势，但放化疗在延长平均生存期方面（19.7个月对14.0个月）并无益处。
