Klaiber Ulla, Mihaljevic André, Hackert Thilo
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Transl Gastroenterol Hepatol. 2019 Feb 3;4:8. doi: 10.21037/tgh.2019.01.07. eCollection 2019.
Extended surgery with arterial resection in pancreatic cancer remains a controversial topic. Although not recommended as a standard procedure, arterial resection may be feasible in selected patients and with the availability of new multimodal treatment approaches it may gain increasing impact in pancreatic cancer therapy as a complete tumor removal is still the only opportunity to achieve long-term survival for this disease. With regard to the surgical approach, one must differentiate between resection and reconstruction of the celiac axis and the hepatic artery as its most important branch, and resection/reconstruction of the superior mesenteric artery. Both procedures are technically possible and require a distinct level of surgical experience as well as interdisciplinary management for preoperative diagnosis and treatment of postoperative complications to achieve good outcomes. Besides arterial resection followed by reconstruction, there are specific situations when arteries may be resected without reconstruction, e.g., during distal pancreatectomy with celiac axis resection. In addition, in some cases arterial resections can be avoided despite a suspected tumor attachment by sharp dissection on the adventitial layer of the respective artery, especially after neoadjuvant therapy which is increasingly performed for borderline resectable and locally advanced tumor findings. This review summarizes definitions, diagnostics, technical aspects and outcomes of arterial resection in pancreatic cancer surgery in the context of the current literature and evidence.
胰腺癌扩大手术联合动脉切除仍是一个有争议的话题。尽管不推荐将其作为标准术式，但对于部分患者，动脉切除可能是可行的。随着新的多模式治疗方法的出现，由于完整切除肿瘤仍是实现该疾病长期生存的唯一机会，动脉切除在胰腺癌治疗中可能会产生越来越大的影响。关于手术方式，必须区分腹腔干及其最重要分支肝动脉的切除与重建，以及肠系膜上动脉的切除/重建。这两种手术在技术上都是可行的，并且需要不同水平的手术经验以及跨学科管理，以进行术前诊断和术后并发症的治疗，从而取得良好的效果。除了动脉切除后进行重建外，在某些特定情况下，动脉可以不进行重建而直接切除，例如在联合腹腔干切除的胰体尾切除术中。此外，在某些情况下，尽管怀疑肿瘤与动脉粘连，但通过在相应动脉外膜层进行锐性分离，可以避免动脉切除，特别是在对临界可切除和局部进展期肿瘤越来越多地进行新辅助治疗之后。本综述结合当前文献和证据，总结了胰腺癌手术中动脉切除的定义、诊断、技术要点和结果。
