Chang David K, Merrett Neil D, Biankin Andrew V
Upper Gastrointestinal Surgery Unit, Bankstown Hospital, Bankstown, Australia.
J Gastroenterol Hepatol. 2008 Jul;23(7 Pt 1):1036-45. doi: 10.1111/j.1440-1746.2008.05471.x.
Despite advances in the understanding and treatment of pancreatic cancer in the last two decades, there is a persisting nihilistic attitude among clinicians. An alarmingly high rate of under-utilization of surgical management for operable pancreatic cancer was recently reported in the USA, where more than half of patients with stage 1 operable disease and no other contraindications were not offered surgery as therapy, denying this group of patients a 20% chance of long-term survival. These data indicate that a nihilistic attitude among clinicians may be a significant and reversible cause of the persisting high mortality of patients with pancreatic cancer. This article examines the modern management of pancreatic cancer, in particular, the advances in surgical care that have reduced the mortality of pancreatectomy to almost that of colonic resection, and outlines a strategy for improving outcomes for patients with pancreatic cancer now and in the future.
尽管在过去二十年里对胰腺癌的认识和治疗取得了进展，但临床医生中仍然存在一种虚无主义态度。最近在美国报道了可手术胰腺癌手术治疗利用不足的惊人高发生率，在那里超过一半的1期可手术疾病且无其他禁忌症的患者未接受手术治疗，剥夺了这组患者20%的长期生存机会。这些数据表明，临床医生中的虚无主义态度可能是胰腺癌患者持续高死亡率的一个重要且可扭转的原因。本文探讨了胰腺癌的现代管理，特别是手术治疗方面的进展，这些进展已将胰腺切除术的死亡率降低到几乎与结肠切除术相同的水平，并概述了改善当前和未来胰腺癌患者治疗效果的策略。
