Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Cancer Lett. 2016 Nov 28;382(2):259-265. doi: 10.1016/j.canlet.2016.01.042. Epub 2016 Jan 29.
Extent of surgery should depend on curability. Improvements in surgical techniques have resulted in surgeons seeking to perform more radical surgery. To date, five randomized controlled trials (RCT) have analyzed the benefits of extended lymphadenectomy for pancreatic head cancer, but none has shown that extended lymphadenectomy enhances patient survival. As most patients with pancreatic cancer have microscopic, locally advanced disease that cannot be cured by surgery alone, local tumor control by extended lymphadenectomy cannot overcome the negative aspects of pre-existing lymph node metastasis. The most important factor improving overall survival following pancreatoduodenectomy in patients with pancreatic head cancer is proper systemic control of the disease rather than extensive local control. The long-term survival outcomes following adjuvant treatment in a large multi-center RCT suggest the need for aggressive systemic treatment. More attention must be paid to the benefits of adjuvant treatment, not only focusing on technical R0 resection. Surgical strategies for patients with pancreatic head cancer require more flexibility, with extent of surgery customized to individual patients, depending on tumor location and disease severity.
手术范围应取决于可治愈性。手术技术的改进促使外科医生寻求进行更激进的手术。迄今为止，已有五项随机对照试验（RCT）分析了扩大淋巴结清扫术对胰头癌的益处，但没有一项试验表明扩大淋巴结清扫术可提高患者的生存率。由于大多数胰腺癌患者的疾病处于微观、局部进展阶段，仅手术无法治愈，因此扩大淋巴结清扫术对局部肿瘤的控制无法克服先前存在的淋巴结转移的负面影响。在胰头癌患者行胰十二指肠切除术之后，改善总体生存的最重要因素是对疾病进行适当的全身控制，而不是广泛的局部控制。一项大型多中心 RCT 中辅助治疗的长期生存结果表明，需要积极的全身治疗。必须更加关注辅助治疗的益处，而不仅仅是关注技术上的 R0 切除。胰头癌患者的手术策略需要更加灵活，根据肿瘤位置和疾病严重程度，为每位患者定制手术范围。
