全胰切除术治疗胰腺癌争议与共识

Controversy and consensus on total pancreatectomy for pancreatic cancer

全胰切除术(TP)在治疗胰腺癌中的价值一直存在争议。TP曾经由于短期和中长期并发症发生率较高、对胰腺癌治疗效果不佳等原因而逐渐减少。然而,近几年随着手术技术和围手术期处理水平的提高,合成胰岛素和胰酶补充药物的出现,TP的安全性和病人术后生存均有改善。目前,胰腺恶性肿瘤行TP的适应证主要是侵犯胰颈部的胰头癌或胰体尾癌、术中冰冻病理学检查示胰腺切缘阳性、多发性胰腺癌或胰腺神经内分泌肿瘤以及累及胰管全程的胰管内乳头状黏液瘤(IPMN)等。对于TP在胰腺癌中的价值,建议在多学科综合治疗协作组(MDT)模式下,选择可从手术切除获益病例,合理选择手术路径,提高手术安全性,实现肿瘤的根治性切除,并提高病人生活质量。

The role of total pancreatectomy（TP） for pancreatic ductal adenocarcinoma（PDAC） has been more controversial. For a number of reasons,over time interest in TP for pancreatic adenocarcinoma has considerably waned. Recent advances in surgical techniques and perioperative management,including insulin therapy and pancreatic enzyme supplementation,enable us to perform TP safely and to improve survival in patients with PDAC. Due to the improved results,there are today more specific indications than before for TP,such as the PDAC involving the pancreatic neck region and extending either from the pancreatic head or the body,multicentric pancreatic cancer or endocrine tumors or IPMN,tumor-positive intraoperative frozen pancreatic transection margin with the need for extension of resection. Clinicians should select appropriate procedures and flexible approaches for patients who may obtain benefit from TP,with the help of multi-disciplinary treatment pattern. Furthermore,we should establish specialized medical team for standardized treatment and improve the safety of radical surgery for pancreatic cancer,improving prognosis of patients as well as post-operative quality of their life.