Distler M, Grützmann R
Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus an der TU Dresden, Dresden.
Pathologe. 2012 Nov;33 Suppl 2:258-65. doi: 10.1007/s00292-012-1639-z.
Ductal adenocarcinoma is the most frequent malignant tumor of the pancreas and total resection of the pancreatic tumor is still the only curative treatment option. Most tumors are located in the pancreatic head, therefore, pylorus-preserving pancreaticoduodenectomy (Whipple PPPD) is the oncological standard procedure. By concentrating pancreatic resections in specialized centers for pancreatic surgery perioperative mortality and morbidity has decreased in recent years. However, pancreatic resections remain complex and difficult operations and pancreatic anastomosis is particular challenging. To achieve complete resection (R0) resection and reconstruction of large venous vessels is often necessary. Resection of arterial vessels is rarely performed and usually does not lead to an R0 resection of the tumor. Currently adjuvant chemotherapy after total tumor resection is standard of care for all tumor stages but neoadjuvant regimes have recently been reported increasingly more often. Advances in translational research has led to a better understanding of tumor biology and new diagnostic options and therapies are expected in the near future.
导管腺癌是胰腺最常见的恶性肿瘤，胰腺肿瘤的全切除仍然是唯一的治愈性治疗选择。大多数肿瘤位于胰头，因此，保留幽门的胰十二指肠切除术（惠普尔手术，PPPD）是肿瘤学的标准手术。近年来，通过将胰腺切除术集中在专门的胰腺手术中心，围手术期死亡率和发病率有所下降。然而，胰腺切除术仍然是复杂且困难的手术，胰腺吻合术尤其具有挑战性。为了实现完整切除（R0），通常需要对大静脉血管进行切除和重建。很少进行动脉血管切除，而且通常不会导致肿瘤的R0切除。目前，全肿瘤切除术后的辅助化疗是所有肿瘤分期的标准治疗，但新辅助治疗方案最近的报道越来越多。转化研究的进展使人们对肿瘤生物学有了更好的理解，预计在不久的将来会有新的诊断方法和治疗手段。
