MDT模式下胰腺癌治疗理念更新与转变

The mode of MDT gives rise to the concept modification about surgical treatments of pancreatic carcinoma

胰腺癌在所有消化道肿瘤中预后最差,治疗极具挑战性。胰腺癌的治疗模式正在由"surgery first"过渡到多学科综合治疗协作组(MDT)模式。提倡对"可能切除"的胰腺癌先给予术前治疗,以提高手术R0切除率,改善病人预后。不同术者、不同中心对"可能切除"胰腺癌的定义及判断标准存在差异,影响了临床研究的可比性,故尚需多中心前瞻性研究进一步验证术前治疗改善病人预后的作用。"潜在可治愈"的胰腺癌包括"可切除"及"可能切除"的病人,该定义体现出审视问题的视角及高度正从外科学向肿瘤学的转变。

Pancreatic carcinoma has the poorest prognosis in all the digestive cancers, and the management is still challenging. Nowadays the treatment strategy of pancreatic carcinoma has been changed from ＂surgery first＂ into the mode of multi-disciplinary team（MDT）. Preoperative therapy is recommended for patients with borderline resectable pancreatic carcinoma so as to increase the R0 rates and improve the prognosis. However, there continues to be a blurring about the definitions of borderline resectability, which are all too often institution and operator dependent. Randomized clinical trials are needed to further evaluate the clinical outcome of preoperative therapy. Both the resectable and borderline resectable tumors could be defined as potentially curable pancreatic cancer. The definition change reflects the conversion from the mode of morphology and surgery to biology and oncology.