Schneider Rick, Späth Christoph, Nitsche Ulrich, Erkan Mert, Kleeff Jörg
Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Department of General Surgery, North Shore Hospital, Auckland, New Zealand.
Minerva Chir. 2017 Oct;72(5):424-431. doi: 10.23736/S0026-4733.17.07410-7. Epub 2017 May 30.
Pancreatic ductal adenocarcinoma (PDAC) is a devastating disease with an overall 5-year survival rate of less than 7%. After many years of basic and clinical research efforts, pancreatic cancer patients presenting with locally advanced, unresectable tumors remain a therapeutic challenge. Despite the lack of high quality randomized controlled trials, perioperative/neoadjuvant treatment strategies seem to be beneficial in these patients. At present the FOLFIRINOX regimen, which was established in the palliative setting, is increasingly recognized as the backbone of neoadjuvant therapy for locally advanced PDAC. Surgical resection follows the same principles and guidelines as upfront surgery specifically regarding the extent of resection including lymphadenectomy, vascular resections and multivisceral resections. Because of the limited diagnostic accuracy of restaging after neoadjuvant treatment, an adjusted intraoperative strategy is necessary to minimize the risk of debulking procedures and maximize the chance of a potential curative resection. Locally advanced PDAC requires a multidisciplinary and individualized treatment approach, and further research efforts for novel and innovative therapies. This article provides an updated overview on strategies to improve the outcome in locally advanced PDAC.
胰腺导管腺癌（PDAC）是一种极具毁灭性的疾病，总体5年生存率低于7%。经过多年的基础和临床研究努力，对于呈现局部晚期、不可切除肿瘤的胰腺癌患者而言，治疗仍然是一项挑战。尽管缺乏高质量的随机对照试验，但围手术期/新辅助治疗策略似乎对这些患者有益。目前，在姑息治疗中确立的FOLFIRINOX方案越来越被视为局部晚期PDAC新辅助治疗的核心方案。手术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，包括淋巴结清扫、血管切除和多脏器切除。由于新辅助治疗后再分期的诊断准确性有限，需要调整术中策略，以尽量降低减瘤手术的风险，并最大限度地提高潜在根治性切除的机会。局部晚期PDAC需要多学科和个体化的治疗方法，以及对新型创新疗法的进一步研究努力。本文提供了关于改善局部晚期PDAC治疗结果策略的最新综述。
