Department of General, Visceral and Transplantation Surgery, Heidelberg, Germany.
Dig Surg. 2017;34(6):441-446. doi: 10.1159/000478539. Epub 2017 Jul 13.
Pancreatic cancer is a low-incident but highly mortal disease. Surgery is still the preferred treatment option for resectable pancreatic cancer as it offers the only realistic chance for cure. As many patients present with locally advanced disease, which is generally considered as not amenable to surgical treatment, it is important to know the limits of surgical therapy in this disease.
In this review, the indication and outcomes of extended pancreatectomies as well as the alternative treatment options for locally advanced pancreatic cancer are described. Furthermore, controversies as well as ongoing and future directions for the treatment options of locally advanced pancreatic cancer are discussed.
Extended pancreatectomy can be performed with higher morbidity and mortality rates in patients with locally advanced pancreatic cancer compared to patients undergoing formal pancreatic resections. These procedures offer significant advantages with respect to both perioperative results and to long-term outcome when compared to chemotherapy.
Due to the higher morbidity and mortality rates, these operations should be limited to specialist units with great experience in pancreatic surgery as well as experience in peri- and post-operative management of patients with pancreatic diseases.
胰腺癌发病率低但死亡率高。手术仍然是可切除胰腺癌的首选治疗方法，因为它是唯一能实现治愈的机会。由于许多患者表现为局部晚期疾病，一般认为不适合手术治疗，因此了解手术治疗在这种疾病中的局限性很重要。
在这篇综述中，描述了扩大胰腺切除术的适应证和结果，以及局部晚期胰腺癌的替代治疗选择。此外，还讨论了局部晚期胰腺癌治疗选择的争议以及正在进行和未来的方向。
与接受正式胰腺切除术的患者相比，局部晚期胰腺癌患者行扩大胰腺切除术的发病率和死亡率更高。与化疗相比，这些手术在围手术期结果和长期预后方面都有显著优势。
由于发病率和死亡率较高，这些手术应仅限于在胰腺手术方面具有丰富经验以及在胰腺疾病的围手术期管理方面具有经验的专科单位进行。
