Department of Surgery, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH 45219, USA.
HPB (Oxford). 2010 Feb;12(1):73-9. doi: 10.1111/j.1477-2574.2009.00136.x.
Borderline resectable pancreatic cancers are technically amenable to surgical resection, but are associated with increased risk of locoregional recurrence. Patients with these tumours may be treated with neoadjuvant therapy in an attempt to improve margin-negative resection rates.
The University of Cincinnati Pancreatic Cancer Database was retrospectively reviewed. Borderline resectable disease was defined by the following radiographic criteria: (i) short segment occlusion of the superior mesenteric vein (SMV), portal vein (PV) or SMV/PV confluence; (ii) short segment hepatic artery encasement, or (iii) superior mesenteric artery/coeliac artery abutment of <180 degrees. Patients with resectable disease who had questionable metastatic disease or poor performance status were also included.
Twenty-nine patients met the criteria. Of these, 26 underwent a full course of neoadjuvant therapy. Twelve (46%) underwent surgical resection and 14 had tumour progression or were deemed unresectable at laparotomy. The most common neoadjuvant therapy regimen was gemcitabine-based chemotherapy alone (58%). Of those undergoing surgery, 67% had margin-negative (R0) resections and 42% required venous resection. Median survival was 15.5 months for unresected patients and 23.3 months for resected patients.
Borderline resectable pancreatic tumours can be treated neoadjuvantly, resulting in margin-negative resection and survival rates similar to those in initially resectable disease.
边界可切除的胰腺癌在技术上可进行手术切除，但与局部区域复发风险增加相关。这些肿瘤患者可以接受新辅助治疗，试图提高无边缘性切除率。
回顾性分析辛辛那提大学胰腺癌数据库。边界可切除疾病的定义为以下影像学标准：（i）肠系膜上静脉（SMV）、门静脉（PV）或 SMV/PV 汇合处短段闭塞；（ii）肝动脉短段包绕，或（iii）肠系膜上动脉/腹腔动脉贴边<180 度。具有可切除疾病的患者，如果有可疑转移性疾病或身体状况不佳，也包括在内。
29 名患者符合标准。其中 26 名患者接受了全程新辅助治疗。12 名（46%）患者接受了手术切除，14 名患者肿瘤进展或剖腹探查时认为不可切除。最常见的新辅助治疗方案是单独使用吉西他滨为基础的化疗（58%）。接受手术的患者中，67%的患者有阴性边缘（R0）切除，42%的患者需要静脉切除。未切除患者的中位生存时间为 15.5 个月，切除患者的中位生存时间为 23.3 个月。
边界可切除的胰腺肿瘤可以进行新辅助治疗，从而实现阴性边缘性切除和生存率，与最初可切除的疾病相似。
