Barreto Savio George, Kleeff Jorg
Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia; College of Medicine and Public Health, Flinders University, South Australia, Australia.
Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany.
Eur J Surg Oncol. 2021 Feb;47(2):480-482. doi: 10.1016/j.ejso.2020.06.028. Epub 2020 Jun 17.
Surgery remains the cornerstone of a multimodality approach aimed at cure in pancreatic cancer (PC). To improve outcomes in PC and widen the indications for surgical resection, surgeons have targeted borderline-resectable (BR) and locally advanced (LA) tumours having demonstrated the feasibility of synchronous arterial (SAR) and venous resections (SVR). However, the true benefit of SARs in PC in terms of improving overall survival has not been fully realised. One of the reasons for this lies in the fact that once the tumour involves the artery, it has already spread along the perineural autonomic plexus that surround it, resulting in early extended local and distant cancer dissemination. Thus, before advocating for the performance of routine SARs in PC, it is important to critically analyse the evidence and develop a structured framework to test if these operations truly hold a beacon of hope for patients with LAPC.
手术仍然是旨在治愈胰腺癌（PC）的多模式治疗方法的基石。为了改善PC的治疗效果并扩大手术切除的适应症，外科医生已将目标对准了边界可切除（BR）和局部晚期（LA）肿瘤，并证明了同步动脉切除（SAR）和静脉切除（SVR）的可行性。然而，SAR在PC中改善总体生存率方面的真正益处尚未完全实现。造成这种情况的原因之一在于，一旦肿瘤累及动脉，它就已经沿着围绕它的神经周围自主神经丛扩散，导致早期局部和远处癌症扩散。因此，在主张对PC进行常规SAR之前，重要的是严格分析证据并制定一个结构化框架，以检验这些手术是否真的为局部晚期胰腺癌患者带来希望之光。
