进展期胰腺癌新辅助治疗后手术时机选择

The optimal time for surgery of locally advanced pancreatic carcinoma treated with neoadjuvant chemotherapy

新辅助治疗常被应用于进展期胰腺癌病人以达到肿瘤降期的目的,从而提高手术的可切除性。而对于手术时机的选择,一直没有定论,存在争议。对于新辅助化疗后转化成功,肿瘤缩小,达到降期的胰腺癌病例,建议直接行手术切除。结合既往前瞻性和回顾性研究报道以及笔者中心的新辅助治疗数据,建议新辅助治疗的疗程为4~6个周期,手术时机建议选择在新辅助治疗后4~8周。对于手术方式的选择,可以考虑先行腹腔镜探查,确认有无转移和初步鉴定手术的可切除性后,再行进一步的手术切除治疗。

Neoadjuvant therapy is often used in locally advanced pancreatic carcinoma patients in order to down tumor stage, and increase the resectability. However, for the optimal time for surgery after neoadjuvant therapy is still controversy. Surgical resection is recommended for patients who have undergone successful neoadjuvant therapy with reduced stage. Combining prospective and retrospective studies and neoadjuvant treatment data from the authors＇ center, the paper suggests that the optimal time for surgery is 4-8 weeks after 4-6 cycles of neoadjuvant therapy. For the choice of surgical approach, laparoseopic exploration can be considered to confirm whether metastatic diseases exist and preliminary identification of reseetability as well, then for further surgical resection.