D'Haese J G, Werner J
Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der Universität München, Standort Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
Radiologe. 2016 Apr;56(4):318-24. doi: 10.1007/s00117-016-0092-z.
Pancreatic cancer is notoriously one of the most aggressive cancers and still has a poor prognosis. Surgical resection is the only chance for a curative therapy approach, with which at least a 5‑year survival can be achieved for 25% of patients. Recent advances in surgical techniques have led to a change in the criteria for resectability.
This review summarizes the currently available evidence on the criteria for resectability of pancreatic cancer and discusses the treatment options.
The study was based on a selective literature search and a summary of the latest data on criteria for resectability is given.
Patients with pancreatic cancer must be differentiated into those with primarily resectable disease, borderline resectable disease, locally advanced (primarily unresectable) and metastatic disease. While infiltration into the major surrounding venous vessels (e.g. superior mesenteric vein, portal vein and confluence of splenic vein) used to be a criterion for unresectable disease, these tumors can nowadays be safely resected in specialized centers. Tumor infiltration into adjacent arteries (e.g. hepatic artery, superior mesenteric artery and celiac artery) remains a clinical problem and surgical resection is often technically possible but associated with an increased morbidity and mortality and therefore not generally recommended. Borderline resectable tumors represent a special group for which neoadjuvant treatment concepts are increasingly being implemented. Radiological therapy response evaluation is challenging after neoadjuvant therapy as it is not usually associated with a radiologically detectable reduction in tumor volume.
Pancreatic resections can nowadays be more radically performed due to advances in surgical techniques. This has led to a change in the criteria for resectability, especially concerning venous tumor infiltration.
胰腺癌是出了名的侵袭性最强的癌症之一，预后仍然很差。手术切除是实现治愈性治疗的唯一机会，通过手术至少25%的患者可实现5年生存。手术技术的最新进展导致了可切除性标准的改变。
本综述总结了目前关于胰腺癌可切除性标准的现有证据，并讨论了治疗选择。
该研究基于选择性文献检索，并给出了可切除性标准的最新数据总结。
胰腺癌患者必须分为主要可切除疾病、临界可切除疾病、局部晚期（主要不可切除）和转移性疾病患者。虽然过去浸润周围主要静脉血管（如肠系膜上静脉、门静脉和脾静脉汇合处）被视为不可切除疾病的标准，但如今在专业中心这些肿瘤可以安全切除。肿瘤浸润相邻动脉（如肝动脉、肠系膜上动脉和腹腔干动脉）仍然是一个临床问题，手术切除在技术上通常可行，但会增加发病率和死亡率，因此一般不推荐。临界可切除肿瘤代表了一个特殊的群体，针对这一群体越来越多地采用新辅助治疗理念。新辅助治疗后放射治疗反应评估具有挑战性，因为它通常不会导致肿瘤体积在影像学上可检测到的缩小。
由于手术技术的进步，如今胰腺癌切除术可以更彻底地进行。这导致了可切除性标准的改变，尤其是在静脉肿瘤浸润方面。
