中国实用外科杂志

中国实用外科杂志

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胰腺癌外科治疗若干热点问题

杨尹默，刘光年，田孝东   

  1. 北京大学第一医院肝胆胰外科，北京 100034
  • 出版日期:2023-07-01

  • Online:2023-07-01

摘要： 近年来，胰腺癌外科治疗理念更新与进步巨大，除了技术方面如手术指征、微创技术、手术入路、切除范围、寡转移灶处理等热点问题外，策略方面如辅助治疗、新辅助治疗、靶向与免疫治疗等更加受到关注。胰腺癌作为系统性疾病，改善病人预后是治疗策略选择的金标准。在外科技术水平不断提高和采用综合治疗模式下，传统形态学“不可切除”的标准不断被突破，手术指征的判断正从“可否切除”过渡至“应否切除”。腹腔镜和机器人辅助手术等微创技术尚不足以证明其肿瘤学优势，但开展例数呈上升态势，应特别注意避免形式上的微创即“微入路”，而实质上的巨创。各种手术入路皆为可行之选，入路服从于解剖的需要，解剖服从于根治的需要，根治服从于预后改善的需要。对于部分新辅助治疗后局部进展期胰腺癌病人，联合腹腔干、肠系膜上动脉切除或动脉鞘剥除有助于提高切除率，降低局部复发率，改善预后。在外科技术潜力发挥已近乎极致的情形下，应理性评价外科治疗的地位和作用。

关键词: 胰腺癌, 手术指征, 手术入路, 动脉鞘剥除, 寡转移

Abstract: Hot issues in surgical treatment of pancreatic cancer                  YANG Yin-mo，LIU Guang-nian，TIAN Xiao-dong.Department of Hepatobiliary and Pancreatic Surgery，Peking University First Hospital，Beijing 100034，China
Corresponding author：TIAN Xiao-dong，E-mail：tianxiao
dong976@139.com
Abstract    In recent years，there has been significant renewal and progress in the philosophy of pancreatic surgery. In addition to technical issues such as surgical indication, minimally invasive techniques, surgical approach, resection margins, and treatment of oligometastases，strategic aspects such as adjuvant therapy，neoadjuvant therapy, targeted therapy, and immunotherapy are receiving increasing attention. On account of pancreatic cancer as a systemic disease, improving patient prognosis is the gold standard for selecting treatment strategies. With the continuous improvement of surgical technology and the development of systemic treatment modalities, the traditional “unresectable” criteria based on morphology are constantly being challenged. The determination of surgical indications is transitioning from “can it be removed” to “should it be removed.” Minimally invasive techniques such as laparoscopy and robot-assisted surgery are not yet widely used in pancreatic cancer surgery and are not sufficient to prove their oncological advantages. However, as the number of cases continues to increase, special attention should be paid to avoid substantial large trauma under the guise of a "micro access route". Various surgical approaches are viable options, while the approach adheres to the needs of the anatomy, the anatomy adheres to the needs of radical treatment, and radical treatment adheres to the needs of prognosis improvement. For some patients with locally advanced pancreatic cancer after neoadjuvant therapy, combined celiac axis resection, superior mesenteric artery resection, and arterial sheath stripping may help increase the resection rate, reduce the local recurrence rate, and improve the long-term prognosis. When the potential of surgical techniques is nearly maximized, we should rationally evaluate the status and role of surgical treatment.

Key words: pancreatic cancer, surgical indications, surgical oppraoch, arterial divestment, oligometastasis