Department of Surgery, TUM School of Medicine, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.
Department of General, Visceral, Vascular, and Transplantation Surgery, Ludwig-Maximilians-University, Munich, Germany.
Dig Surg. 2019;36(6):455-461. doi: 10.1159/000493466. Epub 2018 Nov 8.
One of the main reasons for the dismal prognosis of pancreatic ductal adenocarcinoma (PDAC) is its late diagnosis. At the time of presentation, only approximately 15-20% of all patients with PDAC are considered resectable and around 30% are considered borderline resectable. A surgical approach, which is the only curative option, is limited in borderline resectable patients by local involvement of surrounding structures. In borderline resectable pancreatic cancer (BRPC), neoadjuvant treatment regimens have been introduced with the rationale to downstage and downsize the tumor in order to enable resection and eliminate -microscopic distant metastases. However, there are no official guidelines for the preoperative treatment of BRPC. In the majority of cases, patients are administered -Gemcitabine-based or FOLFIRINOX-based chemotherapy regimens with or without radiation. Radiologic restaging after neoadjuvant therapy has to be judged with caution when it comes to predict tumor response and resectability, since inflammation induced by neoadjuvant therapy may mimic solid tumor. Patients who do not show any disease progression during neoadjuvant therapy should be offered surgical exploration, since a high percentage is likely to undergo resection with negative margins (R0) and, thus, achieve improved overall survival although imaging judged it unlikely. Despite the promising new approaches of neoadjuvant treatment regimens during the last 2 decades, surgery remains the first choice if the tumor appears to be primary resectable at the time of diagnosis. At present, there are no international guidelines regarding the preoperative treatment of BRPC. Therefore, in order to standardize and adjust neoadjuvant treatment in the future, new guidelines have to be determined on the basis of upcoming prospective randomized studies.
胰腺导管腺癌 (PDAC) 预后不佳的主要原因之一是其晚期诊断。在出现时，只有大约 15-20%的 PDAC 患者被认为是可切除的，约 30%的患者被认为是边缘可切除的。手术方法是唯一的治愈方法，但在边缘可切除的患者中，由于周围结构的局部受累，手术方法受到限制。在边缘可切除的胰腺癌 (BRPC) 中，已经引入了新辅助治疗方案，其基本原理是降期和缩小肿瘤，以实现切除并消除 -微小远处转移。然而，对于 BRPC 的术前治疗还没有官方指南。在大多数情况下，患者接受基于 -吉西他滨或 FOLFIRINOX 的化疗方案，有或没有放射治疗。新辅助治疗后的影像学重新分期必须谨慎判断，以预测肿瘤反应和可切除性，因为新辅助治疗引起的炎症可能模仿实体瘤。在新辅助治疗期间没有任何疾病进展的患者应接受手术探查，因为很大一部分患者很可能进行无肿瘤边缘 (R0) 的切除，从而提高总生存率，尽管影像学判断不太可能。尽管在过去 20 年中，新辅助治疗方案有了有希望的新方法，但如果在诊断时肿瘤似乎是原发性可切除的，手术仍然是首选。目前，对于 BRPC 的术前治疗还没有国际指南。因此，为了规范和调整未来的新辅助治疗，必须根据即将进行的前瞻性随机研究来确定新的指南。
