Kleeff J, Stöß C, Yip V, Knoefel W T
Department of Surgery, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, L7 8XP, Liverpool, UK.
Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
Chirurg. 2016 May;87(5):406-12. doi: 10.1007/s00104-016-0184-3.
Pancreatic cancer patients presenting with borderline resectable or locally advanced unresectable tumors remain a therapeutic challenge. Despite the lack of high quality randomized controlled trials, perioperative neoadjuvant treatment strategies are often employed for this group of patients. At present the FOLFIRINOX regimen, which was established in the palliative setting, is the backbone of neoadjuvant therapy, whereas local ablative treatment, such as stereotactic irradiation and irreversible electroporation are currently under investigation. Resection after modern multimodal neoadjuvant therapy follows the same principles and guidelines as upfront surgery specifically regarding the extent of resection, e.g. lymphadenectomy, vascular resection and multivisceral resection. Because it is still exceedingly difficult to predict tumor response after neoadjuvant therapy, a special treatment approach is necessary. In the case of localized stable disease following neoadjuvant therapy, aggressive surgical exploration with serial frozen sections at critical (vascular) margins might be necessary to minimize the risk of debulking procedures and maximize the chance of a curative resection. A multidisciplinary and individualized approach is mandatory in this challenging group of patients.
对于呈现出可切除边界或局部晚期不可切除肿瘤的胰腺癌患者而言，仍然是一项治疗挑战。尽管缺乏高质量的随机对照试验，但围手术期新辅助治疗策略常应用于这组患者。目前，在姑息治疗中确立的FOLFIRINOX方案是新辅助治疗的基础，而局部消融治疗，如立体定向放射治疗和不可逆电穿孔目前正在研究中。现代多模式新辅助治疗后的切除遵循与初次手术相同的原则和指南，特别是在切除范围方面，例如淋巴结清扫、血管切除和多脏器切除。由于新辅助治疗后仍极难预测肿瘤反应，因此需要一种特殊的治疗方法。在新辅助治疗后出现局限性稳定疾病的情况下，可能需要进行积极的手术探查，并在关键（血管）边缘进行连续冰冻切片检查，以尽量降低减瘤手术的风险，并最大化根治性切除的机会。对于这组具有挑战性的患者，多学科和个体化的方法是必不可少的。
