Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, D-81675, Munich, Germany.
Department of General Surgery (Gastrointestinal Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
Langenbecks Arch Surg. 2020 Nov;405(7):879-887. doi: 10.1007/s00423-020-01946-4. Epub 2020 Aug 10.
Neoadjuvant therapies (neoTx) have revolutionized the treatment of borderline resectable (BR) and locally advanced (LA) pancreatic cancer (PCa) by significantly increasing the rate of R0 resections, which remains the only curative strategy for these patients. However, there is still room for improvement of neoTx in PCa.
Here, we aimed to critically analyze the benefits of neoTx in LA and BR PCa and its potential use on patients with resectable PCa. We also explored the feasibility of arterial resection (AR) to increase surgical radicality and the incorporation of immunotherapy to optimize neoadjuvant approaches in PCa.
For early stage, i.e., resectable, PCa, there is not enough scientific evidence for routinely recommending neoTx. For LA and BR PCa, optimization of neoadjuvant therapy necessitates more sophisticated complex surgical resections, machine learning and radiomic approaches, integration of immunotherapy due to the high antigen load, standardized histopathological assessment, and improved multidisciplinary communication.
新辅助治疗（neoTx）通过显著提高 R0 切除率，彻底改变了交界可切除（BR）和局部晚期（LA）胰腺癌（PCa）的治疗方法，而 R0 切除仍然是这些患者唯一的治愈策略。然而，PCa 的 neoTx 仍有改进的空间。
在这里，我们旨在批判性地分析 neoTx 在 LA 和 BR PCa 中的益处及其在可切除 PCa 患者中的潜在用途。我们还探讨了动脉切除术（AR）增加手术根治性的可行性，以及免疫疗法的应用以优化 PCa 的新辅助方法。
对于早期，即可切除的 PCa，没有足够的科学证据常规推荐 neoTx。对于 LA 和 BR PCa，新辅助治疗的优化需要更复杂的复杂手术切除、机器学习和放射组学方法、由于抗原负荷高而整合免疫疗法、标准化的组织病理学评估以及改进的多学科沟通。
