Alexakis N, Halloran C, Raraty M, Ghaneh P, Sutton R, Neoptolemos J P
Department of Surgery, University of Liverpool, Royal Liverpool University Hospital, 5th floor, UCD Building, Daulby Street, Liverpool L69 3GA, UK.
Br J Surg. 2004 Nov;91(11):1410-27. doi: 10.1002/bjs.4794.
Pancreatic cancer carries a dismal prognosis but there has been a vast increase in evidence on its management in the past decade.
An electronic and manual search was performed for articles on the surgical treatment of pancreatic cancer published in the past 10 years.
Six major areas of advancement were identified. Groups at high risk of developing pancreatic cancer, notably those with chronic pancreatitis and hereditary pancreatitis, have been defined, raising the need for secondary screening. Methods of staging pancreatic cancer for resection have greatly improved but accuracy is still only 85-90 per cent. Pylorus-preserving partial pancreatoduodenectomy without extended lymphadenectomy is the simplest procedure; it does not compromise long-term survival. Adjuvant chemotherapy significantly improves long-term survival. Patients who are free from major co-morbidity have better palliation by surgery (with a double bypass) than by endoscopy. High-volume centres improve the results of surgery for all outcome measures including long-term survival.
The surgical management of pancreatic cancer has undergone a significant change in the past decade. It has moved away from no active treatment. The standard of care can now be defined as potentially curative resection in a specialist centre followed by adjuvant systemic chemotherapy.
胰腺癌预后不佳，但在过去十年中，其治疗方面的证据大幅增加。
对过去10年发表的关于胰腺癌外科治疗的文章进行了电子和人工检索。
确定了六个主要进展领域。已明确了胰腺癌高危人群，尤其是那些患有慢性胰腺炎和遗传性胰腺炎的人群，这增加了二级筛查的必要性。胰腺癌切除术前的分期方法有了很大改进，但准确率仍仅为85%至90%。保留幽门的部分胰十二指肠切除术且不进行扩大淋巴结清扫是最简单的手术；它不会影响长期生存率。辅助化疗可显著提高长期生存率。无重大合并症的患者通过手术（双旁路手术）比通过内镜检查能获得更好的姑息治疗效果。高手术量中心在包括长期生存在内的所有结局指标上都能改善手术效果。
在过去十年中，胰腺癌的外科治疗发生了重大变化。它已从无积极治疗转变。现在的护理标准可定义为在专科中心进行潜在可治愈的切除，随后进行辅助全身化疗。
