胰腺癌外科治疗新进展

胰腺癌的诊断和治疗问题仍极具挑战性。虽无前瞻性的研究结果报道，仍提倡对“可切除”及“可能切除”的胰腺癌患者进行新辅助治疗，以提高R0切除率。近年来针对腹膜后切缘问题不断有术式改进的报告，如动脉优先入路、提拉悬吊技术、钩突优先入路等，丰富了传统的切除方式。鉴于病理学对R0及R1切除判断标准的再评价，应重新审视R1切除对改善患者预后的价值和意义。在淋巴结清扫范围方面，基于若干临床随机对照研究结果，以日本胰腺学会淋巴结分组为基础，目前研究者们普遍认为应清扫至第二站淋巴结。由解剖学层面对胰腺系膜的探讨及临床应用有助于提高腹膜后切缘的阴性率。

New advances in the treatment of pancreatic carcinoma

Pancreatic carcinoma is still a challenging disease. Although there is no randomized controlled trial （RCT） results, neoadjuvant therapy is encouraged to perform on patients with “borderline resectable” or “resectable” pancreatic cancers, which could probably increase the R0 resection rates. There has been some modifications about resection approach in recent years, for example, artery first, hanging maneuver, uncinate process first, etc, which seem as safe and effective options. Because of the modification of pathologic classification of R0 and R1 resection for pancreatic cancer, the clinical outcomes of R1 resection need to be reevaluated. The extent of lymphadenectomyin pancreaticoduodenectomy remains controversial. Based on several RCT reports, dissection of 2nd group of lymph nodes is recommended according to the Japan Pancreas Society classification. The discussion and clinical application about the concept of mesopancreas will help to improve the status of retroperitoneal margins via standardized surgical procedures.