Lesmana Cosmas Rinaldi Adithya
Hepatobiliary Division, Internal Medicine Department, Dr. Cipto Mangunkusumo National General Hospital, Universitas Indonesia, Jakarta 10430, Indonesia.
Digestive Disease and Gastrointestinal Oncology Center, Medistra Hospital, Jakarta 12950, Indonesia.
World J Gastrointest Surg. 2023 Feb 27;15(2):163-168. doi: 10.4240/wjgs.v15.i2.163.
Pancreatic malignancy is still the most lethal gastrointestinal malignancy. It has a very poor prognosis with low survival rate. Surgery is still the main treatment option for pancreatic malignancy. Most patients already have locally advanced and even late stage disease due to non-specific abdominal symptoms. Even though some cases are still suitable for surgical treatment, due to its aggressiveness adjuvant chemotherapy is becoming the standard treatment for controlling the disease. Radiofrequency ablation (RFA) is a thermal therapy that has been used as one of the standard treatments for liver malignancy. It can also be performed intraoperatively. There are several reports on percutaneous RFA treatment for pancreatic malignancy using transabdominal ultrasound and guided by computed tomography scan. However, due to its anatomical location and the risk of high radiation exposure, these methods seem to be very limited. Endoscopic ultrasound (EUS) has been widely used for pancreatic abnormality evaluation due to its ability to detect more accurately, especially small pancreatic lesions, compared to other imaging modalities. By the EUS approach, it is easier to achieve good visualization of tumor ablation and necrosis as the echoendoscope position is closer to the tumor area. Based on studies and a recent meta-analysis, EUS-guided RFA is a promising treatment approach for most pancreatic malignancy cases, but most studies only collected data from a small sample size. Larger studies are needed before clinical recommendations can be made.
胰腺恶性肿瘤仍然是最致命的胃肠道恶性肿瘤。其预后很差，生存率低。手术仍然是胰腺恶性肿瘤的主要治疗选择。由于腹部症状不具特异性，大多数患者就诊时已处于局部晚期甚至晚期。尽管有些病例仍适合手术治疗，但鉴于其侵袭性，辅助化疗正成为控制该病的标准治疗方法。射频消融（RFA）是一种热疗，已被用作肝脏恶性肿瘤的标准治疗方法之一，也可在术中进行。有几篇关于经皮RFA治疗胰腺恶性肿瘤的报道，采用经腹超声并在计算机断层扫描引导下进行。然而，由于胰腺的解剖位置以及高辐射暴露风险，这些方法似乎非常有限。与其他成像方式相比，内镜超声（EUS）因其能够更准确地检测，尤其是小的胰腺病变，已被广泛用于胰腺异常评估。通过EUS途径，由于超声内镜位置更靠近肿瘤区域，更容易实现对肿瘤消融和坏死的良好可视化。基于研究和最近的一项荟萃分析，EUS引导下的RFA对大多数胰腺恶性肿瘤病例来说是一种有前景的治疗方法，但大多数研究仅收集了小样本量的数据。在做出临床推荐之前，还需要更大规模的研究。
