Dhayat Sameer A, Mirgorod Philip, Lenschow Christina, Senninger Norbert, Anthoni Christoph, Vowinkel Thorsten
Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany.
PLoS One. 2017 Mar 7;12(3):e0173374. doi: 10.1371/journal.pone.0173374. eCollection 2017.
Pancreatic ductal adenocarcinoma (PDAC) remains one of the most deadly cancers in Europe and the USA. There is consensus that radical tumor surgery is the only viable option for any long-term survival in patients with PDAC. So far, limited data are available regarding the routine surgical management of patients with advanced PDAC in the light of surgical guidelines.
A national survey on perioperative management of patients with PDAC and currently applied criteria on their tumor resectability in German university and community hospitals was carried out.
With a response rate of 81.6% (231/283) a total of 95 (41.1%) participating departments practicing pancreatic surgery in Germany are certified as competence and reference centers for surgical diseases of the pancreas in 2016. More than 95% of them indicate to carry out structured and interdisciplinary therapies along with an interdisciplinary pre- and postoperative tumor board. The majority of survey respondents prefer the pylorus-preserving partial pancreatoduodenectomy (93.1%) with standard lymphadenectomy for cancer of the pancreatic head. Intraoperative histological evaluation of the resection margins is used regularly by 99% of the survey respondents. 98.7% of survey respondents carry out partial or complete vein resection, 126 respondents (54.5%) would resect tumor adjacent arteries, and 102 respondents (44.2%) would perform metastasectomy if complete PDAC resection (R0) is possible.
Evidence-based and standardized pancreatic surgery is practiced by a large number of hospitals in Germany. However, a significant number of survey respondents support an extended radical tumor resection in patients with advanced PDAC even when not indicated by current clinical guidelines.
胰腺导管腺癌（PDAC）仍是欧洲和美国最致命的癌症之一。人们一致认为，根治性肿瘤手术是PDAC患者实现长期生存的唯一可行选择。到目前为止，关于晚期PDAC患者根据手术指南进行常规手术管理的数据有限。
在德国大学和社区医院开展了一项关于PDAC患者围手术期管理及其肿瘤可切除性现行标准的全国性调查。
回复率为81.6%（231/283），2016年德国共有95个（41.1%）参与胰腺手术的科室被认证为胰腺外科疾病的能力和参考中心。其中超过95%的科室表示会开展结构化和跨学科治疗，并设有跨学科的术前和术后肿瘤讨论组。大多数调查受访者倾向于对胰头癌采用保留幽门的胰十二指肠切除术（93.1%）并进行标准淋巴结清扫。99%的调查受访者经常使用术中切缘的组织学评估。98.7%的调查受访者会进行部分或完全静脉切除，126名受访者（54.5%）会切除肿瘤邻近动脉，102名受访者（44.2%）表示如果有可能实现PDAC的完全切除（R0），会进行转移灶切除术。
德国大量医院实施了基于证据的标准化胰腺手术。然而，相当数量的调查受访者支持对晚期PDAC患者进行扩大根治性肿瘤切除，即使当前临床指南未作此推荐。
