Powell-Brett Sarah, Pande Rupaly, Roberts Keith J
Department of Hepatopancreatobiliary Surgery and Liver Transplantation, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK.
Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK.
Cancers (Basel). 2021 Apr 1;13(7):1669. doi: 10.3390/cancers13071669.
Improving outcomes among patients with resectable pancreatic cancer is one of the greatest challenges of modern medicine. Major improvements in survival will result from the development of novel therapies. However, optimising existing pathways, so that patients realise benefits of already proven treatments, presents a clear opportunity to improve outcomes in the short term. This narrative review will focus on treatments and interventions where there is a clear evidence base to improve outcomes in pancreatic cancer, and where there is also evidence of variation and under-treatment. Avoidance of preoperative biliary drainage, treatment of pancreatic exocrine insufficiency, prehabiliation and enhanced recovery after surgery, reducing perioperative complications, optimising opportunities for elderly patients to receive therapy, optimising adjuvant chemotherapy and regular surveillance after surgery are some of the strategies discussed. Each treatment or pathway change represents an opportunity for marginal gain. Accumulation of marginal gains can result in considerable benefit to patients. Given that these interventions already have evidence base, they can be realised quickly and economically.
改善可切除胰腺癌患者的治疗效果是现代医学面临的最大挑战之一。新型疗法的开发将带来生存率的重大提升。然而，优化现有治疗途径，使患者能够从已被证实的治疗方法中获益，为短期内改善治疗效果提供了明确的契机。本叙述性综述将聚焦于那些有明确证据可改善胰腺癌治疗效果，且存在治疗差异和治疗不足证据的治疗方法和干预措施。讨论的策略包括避免术前胆道引流、治疗胰腺外分泌功能不全、术前康复和术后加速康复、减少围手术期并发症、优化老年患者接受治疗的机会、优化辅助化疗以及术后定期监测。每一项治疗或治疗途径的改变都代表着微小进步的机会。微小进步的积累可为患者带来可观的益处。鉴于这些干预措施已有证据支持，它们能够快速且经济地得以实现。
