中国实用外科杂志

中国实用外科杂志

• 专家论坛 • 上一篇    下一篇

远处转移胰腺癌手术切除是否合理——国际胰腺病学协会和日本胰腺学会立场声明解读

浦    宁，刘    亮，楼文晖   

  1. 复旦大学附属中山医院胰腺外科，上海 200032
  • 出版日期:2023-09-01

  • Online:2023-09-01

摘要： 胰腺癌恶性程度高，预后极差，多数病人确诊时已发生远处器官转移，例如肝脏和腹膜转移。远处转移不可切除胰腺癌的标准治疗方式为化疗，但总体预后仍较差。随着化疗的突破性进展，近年来预后逐渐改善，部分病人的转移灶明显缩小或消失。面对新的临床问题，临床上逐渐开始尝试将寡转移灶与原发肿瘤联合切除，亦或在一段期间的抗癌治疗获得良好反应后同步行原发肿瘤和转移灶切除。2022年7月6日，外科治疗转移性胰腺癌的国际共识会议在日本京都举办的第26届国际胰腺病学协会会议暨第53届日本胰腺学会年会期间召开。该共识会议总结了转移性胰腺癌的标准治疗方式、手术指征、手术时机、转化手术临床疗效、复发模式及术后辅助化疗作用等，最终旨在揭示转移性胰腺癌手术治疗的现状，并为将来的临床试验和指南制定提供依据。

关键词: 胰腺癌, 转移性胰腺癌, 肝转移, 腹膜转移, 转化手术, 化疗

Abstract: Is surgical resection reasonable for distant metastatic pancreatic cancer - Interpretation of the position statement from the International Association of Pancreatology and the Japan Pancreas Society        PU Ning, LIU Liang, LOU Wen-hui. Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Corresponding author: LOU Wen-hui, E-mail:lou.wenhui@zs-hospital.sh.cn
Abstract    Pancreatic ductal adenocarcinoma（PDAC）is highly malignant with an extremely poor prognosis. Most patients are often found with distant organ metastasis when diagnosed, such as liver and peritoneal metastasis. Chemotherapy is the standard treatment for unresectable metastatic PDAC（UR-M PDAC）, but the prognosis remains poor. With the breakthrough of chemotherapy, the prognosis is gradually improved, and some patients have experienced obvious shrinkage or disappearance of their metastatic lesions. Faced with new clinical problems, attempts have been made to remove oligometastases in combination with the primary tumor, or to remove both the primary tumor and metastases after a period of anticancer therapy with favorable response. On July 6,2022,an international consensus meeting on surgical treatment for UR-M PDAC was held during the 26th Meeting of the International Association of Pancreatology（IAP）and the 53rd Annual Meeting of the Japan Pancreas Society（JPS）in Kyoto, Japan. The consensus meeting summarized the standard treatment modalities, surgical indications,surgical appropriate timing, clinical efficacy of conversion surgery, recurrence pattern, and postoperative adjuvant chemotherapy for UR-M PDAC, and ultimately aimed to reveal the current status of surgical treatment for UR-M PDAC, and provide evidence for future clinical trials and guideline development.

Key words: pancreatic cancer, metastatic pancreatic ductal adenocarcinoma, liver metastasis, peritoneal metastasis, conversion surgery, chemotherapy