边界性可切除胰腺导管腺癌的诊治现状

The status of diagnosis and treatment of borderline resectable pancreatic ductal adenocarcinoma

目的总结目前边界性可切除胰腺导管腺癌(BR-PDAC)的诊治情况及进展。方法通过文献检索,就近年来BR-PDAC的诊断和治疗进行综述,总结BR-PDAC的定义、治疗及治疗效果。结果近年来胰腺外科已经有了很大的进步,特别是在血管重建和多脏器联合切除方面已经能够对以往不能手术的胰腺导管腺癌患者进行根治性切除。2014年国际胰腺外科学组(ISGPS)对BR-PDAC进行了定义。目前,对BR-PDAC是先直接手术切除还是先进行新辅助治疗后再手术存在许多争议。BR-PDAC诊治的关键是,术前进行精确的评估以确定肿瘤的可切除性,以及外科的根治性切除联合新辅助治疗。结论外科手术结合新辅助治疗是BR-PDAC患者唯一有可能获得长期生存的治疗方式。

Objective To summarize the diagnosis and treatment progress of borderline resectable pancreatic ductal adenocarcinoma（BR-PDAC） in recent years.Methods Through the retrieval of relevant literatures,the progress in the diagnosis and treatment of BR-PDAC in recent years were reviewed,to summarize the current status of definition,management,and outcome of BR-PDAC.Results Pancreatic surgery had significantly changed during the past years and resection approaches had been extended beyond standard procedures,including vascular and multivisceral resections.Consequently,BR-PDAC,which had recently been defined by the International Study Group for Pancreatic Surgery（ISGPS）,had become a controversial issue with regard to its management in terms of upfront resection vs.neoadjuvant treatment and sequential resection.The key point was preoperative diagnostic accuracy to define the resectability of BRPDAC and radical tumor resection followed by neoadjuvant treatment.Conclusion Surgery followed by neoadjuvant treatment is the only treatment option for BR-PDAC with the chance of long-term survival.