胰腺癌外科治疗的历史和现状

胰腺癌的发病率呈逐年上升趋势,其切除率低、预后差,手术切除是唯一可能根治的治疗方法。近年来胰腺癌的外科治疗取得了长足的进步,围手术期病死率和术后并发症发生率均显著下降,但其手术切除率和远期疗效仍不尽人意。胰十二指肠切除术经历了原形的出现、日臻完善和标准化模式3个阶段,这期间许多学者对手术进行了探索。近年来,对于胰腺癌规范化淋巴结清扫已形成共识,提倡在临床研究前提下争取R_0切除的扩大淋巴结清扫,能提高手术切除率的联合静脉切除已为外科医生普遍接受,联合动脉切除多数持否定态度,对于有远处转移的少数病例,经过选择可行联合脏器切除。新辅助治疗已成当下热点,但其适应症与具体的治疗方案尚无一致的意见。胰腺癌分子病理分型标志着人们对这种高度异质性肿瘤的深入认识,将为根本改善胰腺癌的治疗现状带来希望。本文就胰腺癌外科治疗的历史和现状作一概述。

The surgical treatment of pancreatic cancer: history and present state

The prevalence of pancreatic cancer, which is characterized by low resection rates and dismal prognosis, is increasing with the years. Surgical resection remains the only possible radical treatment for this condition. Great progress has been achieved in surgical treatment of pancreatic cancer in recent years, as evidenced by the dramatically decreased perioperative mortality rates and incidence of postoperative complications, but the surgical resection rates and long-term results are still disappointing. The development of pancreatoduodenectomy has gone through three stages: the emergence of prototypical procedure, gradual maturity and perfection, and procedure standardization, to which, tremendous contributions have been made by a number of scholars. At present, a consensus on standardized lymphadenectomy for pancreatic cancer has been reached, and advocation of expanded lymphadenectomy for achieving a R0 resection on the basis of clinical research and the combined venous resection for improving resection rates have gained general acceptance by surgeons, but majority of them hold negative attitudes towards the combined arterial resection, with agreements on the feasibility of combined organ resection in a small number of cases with distant metastases after selection. Neoadjuvant therapy has become an intense area, but there is no consensus about the indications and detailed treatment suggestions so far. The molecular pathological classification for pancreatic cancer indicates the gain of deep understanding of this highly heterogeneous tumor, which will open a new avenue to break through the current challenges. Here, the authors overview the history and current state of surgical treatment for pancreatic cancer.