本文内容已经过同行评议,以优先出版方式在线发表,可作为有效引用数据。由于优先发表的内容尚未完成规范的编校流程,《中华外科杂志》不保证其数据与印刷版内容的完全一致。 【引用本文】杨尹默.当下可 未来可期:胰腺癌外科治疗若干热点问题[J/OL].中华外科杂志,2022,61:网络预发表. 杨尹默 {北京大学第一医院外科} Email:yangyinmo@263.net 在目前消化道肿瘤系统治疗的大背景下,胰腺癌的诊疗模式从既往的“surgery first”转变为多学科综合治疗,该转变对外科治疗的地位及方式等均产生了深刻影响。此外,最近20多年,胰腺外科在手术理念及技术层面的更新与进步巨大,能量平台、腹腔镜与机器人手术系统等的应用日趋广泛,在显著提高胰腺手术安全性及切除率的同时,也衍生出对手术指征、手术时机、切除范围等传统外科问题的再审视与思考,且不断有相应的临床实践进行探索,但基于胰腺癌的高度异质性,结论不尽一致,甚至存在较大争议,体现出胰腺恶性肿瘤的特殊性、复杂性与难治性。近年来胰腺癌外科治疗的技术热点,可以归纳为可切除性、根治性、安全性及微创性等几个方面,本文述评了相关进展与争议,并对未来的发展方向进行展望。 一、胰腺癌可切除性评估:从能否切除到应否切除 二、根治性问题 三、安全性:胰肠吻合与胰瘘 四、微创理念与技术在胰腺外科的应用 参考文献 (在框内滑动手指即可浏览) [1]杨尹默.胰腺癌可切除性评估标准:形态学还是生物学?[J].中华外科杂志,2022,60(7):641-645.DOI:10.3760/cma.j.cn112139-20220429-00191. [2]中华医学会外科学分会胰腺外科学组.中国胰腺癌诊治指南(2021)[J].中华外科杂志,2021,59(7):561-577.DOI: 10.3760/cma.j.cn112139-20210416-00171. [3]KobayashiS,OtsuboT,NakanoH,et al. Complete lymphadenectomy around the entire superior mesenteric artery improves survival in artery-first approach pancreatoduodenectomy for T3 pancreatic ductal adenocarcinoma[J].World J Surg,2021,45(3):857-864. DOI: 10.1007/s00268-020-05856-w. [4]HironoS,KawaiM,OkadaKI,et al. Complete circumferential lymphadenectomy around the superior mesenteric artery with preservation of nerve plexus reduces locoregional recurrence after pancreatoduodenectomy for resectable pancreatic ductal adenocarcinoma[J].Eur J Surg Oncol,2021,47(10):2586-2594. DOI: 10.1016/j.ejso.2021.06.005. [5]ImamuraT,YamamotoY,SugiuraT,et al. Reconsidering the optimal regional lymph node station according to tumor location for pancreatic cancer[J].Ann Surg Oncol,2021,28(3):1602-1611. DOI: 10.1245/s10434-020-09066-5. [6]NegoiI,HostiucS,RuncanuA,et al. Superior mesenteric artery first approach versus standard pancreaticoduodenectomy: a systematic review and meta-analysis[J].Hepatobiliary Pancreat Dis Int,2017,16(2):127-138. DOI: 10.1016/s1499-3872(16)60134-0. [7]SabaterL,CugatE,SerrabloA,et al. Does the artery-first approach improve the rate of R0 resection in pancreatoduodenectomy?: a multicenter, randomized, controlled trial[J].Ann Surg,2019,270(5):738-746. DOI: 10.1097/SLA.0000000000003535. [8]CaiB,LuZ,NeoptolemosJP,et al. Sub-adventitial divestment technique for resecting artery-involved pancreatic cancer: a retrospective cohort study[J].Langenbecks Arch Surg,2021,406(3):691-701. DOI: 10.1007/s00423-021-02080-5. [9]HabibJR,Kinny-KösterB,van OostenF,et al. Periadventitial dissection of the superior mesenteric artery for locally advanced pancreatic cancer: Surgical planning with the “halo sign” and “string sign”[J].Surgery,2021,169(5):1026-1031. DOI:10.1016/j.surg.2020.08.031. [10]SchneiderM, HackertT, StrobelO,et al. Technical advances in surgery for pancreatic cancer[J].Br J Surg,2021,108(7):777-785. DOI: 10.1093/bjs/znab133. [11]HackertT,StrobelO,MichalskiCW,et al. The TRIANGLE operation-radical surgery after neoadjuvant treatment for advanced pancreatic cancer:a single arm observational study[J].HPB (Oxford),2017,19(11):1001-1007. DOI: 10.1016/j.hpb.2017.07.007. [12]KlotzR,HackertT,HegerP,et al. The TRIANGLE operation for pancreatic head and body cancers: early postoperative outcomes[J].HPB(Oxford),2022,24(3):332-341. DOI: 10.1016/j.hpb.2021.06.432. [13]WuW, MiaoY, YangY, et al. Real-world study of surgical treatment of pancreatic cancer in China: annual report of China Pancreas Data Center(2016-2020)[J]. J Pancreatol,2022,5(1):1-9. DOI: 10.1097/JP9.0000000000000086. [14]ZhangH,LanX,PengB,et al. Is total laparoscopic pancreaticoduodenectomy superior to open procedure? A Meta-analysis[J].World J Gastroenterol,2019,25(37):5711-5731. DOI: 10.3748/wjg.v25.i37.5711. [15]Da DongX,FelsenreichDM,GognaS,et al. Robotic pancreaticoduodenectomy provides better histopathological outcomes as compared to its open counterpart: a meta-analysis[J].Sci Rep,2021,11(1):3774. DOI: 10.1038/s41598-021-83391-x. |
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