胰腺癌外科治疗的热点与难点

Highlights and difficulties in surgical treatment for pancrea-tic carcinoma

近年来胰腺癌的手术安全性及切除率有了较大提高，但患者预后无显著改善，胰腺癌的治疗仍极具挑战性。胰腺癌的治疗模式正逐步由“surgeryfirst”过渡到多学科团队诊断与治疗模式。手术切除是患者得以根治的唯一可能方式。近年来研究者对联合血管切除、淋巴结清扫范围、全胰腺系膜切除临床意义的认识不断深入。以“1mm原则”定义R1切除，则大多数胰腺癌的切除为R1切除，但仍可使患者获益。对围术期并发症的定义标准趋于统一规范。研究者提倡对可能切除的胰腺癌开展新辅助治疗。

Pancreatic carcinoma is still a challenging disease, although the resection rate and the operative safety have been improved, the prognosis of the patients is dismal. Now the therapy strategy is changed from ＂surgery first＂ into the mode of muhidisciplinary team （MDT）. Surgical resection is the only curable therapy for pancreatic carcinoma. Recently, the clinical role of extent of lymphadenectomy, combined vascular resection, and total mesopancreas excision was recognized more deeply. If ＂1 mm rule＂ is applied to define the resection margin, most pancreatic cancer resections are R1 resections, which benefit the patients. There has been consensus on the definition of peri- operative complications. Neoadjuvant therapy is advocated for patients with borderline resectable pancreatic carcinoma.