Abstract:

Consensus and controversy on the radical resection range of pancreatic cancer        LOU Wen-hui, FANG Yuan. Department of Pancreatic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Correspongding author:LOU Wen-hui, E-mail：lou.wenhui@
zs-hospital.sh.cn
Abstract    Pancreatic cancer has the worst prognosis in all the digestive malignant tumors. Local recurrence, lymph node and distant metastasis are the key prognostic factors and resection range of pancreatic cancer has been gone through 3 stages: first stage was the improvement of surgical safety from Doc Whipple performed the first pancreaticoduodenectomy to the 1960s; the next stage was the extended pancreatectomy including extended lymphadenectomy, combined vascular resection and reconstruction, and total pancreatectomy；recently the resection range has changed to standard lymphadenectomy since the RCT results did not show survival benefit after 2000. Although expert consensus  had been reached on the radical resection range of pancreatic cancer, the efficacy was not satisfied. Surgeons need to understand the biological behavior of pancreatic cancer and pay attention to the value of combined chemoradiotherapy.

Key words: pancreatic cancer, pancreaticoduodenectomy, lymphadenectomy, prognosis

摘要：

胰腺癌是预后极差的消化道肿瘤，局部复发、淋巴转移和远处转移是影响病人预后的关键因素。为解决这一问题，外科医生针对手术切除范围进行了3个阶段的探索：从Whipple医生开展胰十二指肠切除术到20世纪60年代是安全性改善阶段；之后至2000年的30年间，扩大淋巴结清扫、联合血管切除重建、全胰腺切除成为研究热点；随着2000年以后多项随机对照研究的开展，手术范围扩大并未带来生存优势使外科医生逐渐向标准淋巴结清扫回归，也形成了关于切除范围的指南和共识，但疗效尚不满意。外科医生意识到需要重视肿瘤生物学性质对预后的影响，应联合化疗、放疗以改善疗效。

关键词: 胰腺癌, 胰十二指肠切除术, 淋巴结清扫, 预后