Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Cancer Lett. 2016 Jun 1;375(2):231-237. doi: 10.1016/j.canlet.2016.02.039. Epub 2016 Mar 9.
Surgery followed by adjuvant chemotherapy remains the only treatment option for pancreatic ductal adenocarcinoma (PDAC) with the chance of long-term survival. If a radical tumor resection is possible, 5-year survival rates of 20-25% can be achieved. Pancreatic surgery has significantly changed during the past years and resection approaches have been extended beyond standard procedures, including vascular and multivisceral resections. Consequently, borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC), which has recently been defined by the International Study Group for Pancreatic Surgery (ISGPS), has become a controversial issue with regard to its management in terms of upfront resection vs. neoadjuvant treatment and sequential resection. Preoperative diagnostic accuracy to define resectability of PDAC is a keypoint in this context as well as the surgical and interdisciplinary expertise to perform advanced pancreatic surgery and manage complications. The present mini-review summarizes the current state of definition, management and outcome of BR-PDAC. Furthermore, the topic of ongoing and future studies on neoadjuvant treatment which is closely related to borderline resectability in PDAC is discussed.
手术联合辅助化疗仍然是唯一有机会长期生存的治疗方法。如果可以进行根治性肿瘤切除术，5 年生存率可以达到 20-25%。在过去的几年中，胰腺手术发生了显著变化，切除方法已经超出了标准手术范围，包括血管和多脏器切除术。因此，最近国际胰腺外科学会（ISGPS）定义的边界可切除胰腺导管腺癌（BR-PDAC）在直接切除与新辅助治疗及序贯切除方面的处理成为一个有争议的问题。术前诊断准确性对于确定 PDAC 的可切除性是这方面的关键点，此外还需要有进行先进胰腺手术和处理并发症的外科和多学科专业知识。本迷你综述总结了 BR-PDAC 的当前定义、管理和结果。此外，还讨论了与 PDAC 边界可切除性密切相关的新辅助治疗的正在进行和未来的研究课题。
