Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 54642 Thessaloniki, Greece.
Hepatobiliary Pancreat Dis Int. 2011 Feb;10(1):21-5. doi: 10.1016/s1499-3872(11)60002-7.
Adenocarcinoma of the pancreas exhibits aggressive behavior in growth, inducing an extremely poor prognosis with an overall median 5-year survival rate of only 1%-4%. Curative resection is the only potential therapeutic opportunity.
A PubMed search of relevant articles published up to 2009 was performed to identify information about the value of lymphadenectomy and its extent in curative resection of pancreatic adenocarcinoma.
Despite recent advances in chemotherapy, radiotherapy or even immunotherapy, surgery still remains the major factor that affects the outcome. The initial promising performance in Japan gave conflicting results in Western countries for the extended and more radical pancreatectomy; it has failed to prove beneficial. Four prospective, randomized trials on extended versus standard lymphadenectomy during pancreatic cancer surgery have shown no improvement in long-term survival by the extended resection. The exact lymph node status, including malignant spread and the total number retrieved as well as the lymph node ratio, is the most important prognostic factor. Positive lymph nodes after pancreatectomy are present in 70%. Paraaortic lymph node spread indicates poor prognosis.
Undoubtedly, a standard lymphadenectomy including >15 lymph nodes must be no longer preferred in patients with the usual head location. The extended lymphadenectomy does not have any place, unless in randomized trials. In cases with body or tail location, the radical antegrade modular pancreatosplenectomy gives promising results. Nevertheless, accurate localization and detailed examination of the resected specimen are required for better staging.
胰腺腺癌在生长过程中表现出侵袭性行为，导致预后极差，总体中位 5 年生存率仅为 1%-4%。根治性切除是唯一有潜在治疗机会的方法。
对截至 2009 年发表的相关文章进行了 PubMed 检索，以确定淋巴结切除术及其在胰腺腺癌根治性切除中的范围的价值信息。
尽管化疗、放疗甚至免疫治疗最近有所进展，但手术仍然是影响结果的主要因素。日本最初令人鼓舞的表现在西方国家对扩大和更激进的胰切除术产生了矛盾的结果；它未能证明有益。四项关于在胰腺癌手术中进行扩大与标准淋巴结清扫的前瞻性随机试验表明，扩大切除并未改善长期生存。确切的淋巴结状态，包括恶性扩散和检出的总淋巴结数以及淋巴结比率，是最重要的预后因素。胰切除术后阳性淋巴结的存在率为 70%。腹主动脉旁淋巴结转移预示预后不良。
毫无疑问，对于通常位于头部的患者，不再需要标准的包括>15 个淋巴结的淋巴结清扫。除非在随机试验中，扩大淋巴结清扫术没有任何作用。对于体部或尾部的病例，根治性顺行模块胰脾切除术可获得有希望的结果。然而，需要准确的定位和对切除标本的详细检查以进行更好的分期。
