胰头癌行腹腔镜胰十二指肠切除术的争议与共识

Controversy and consensus on laparoscopic pancreaticoduodenectomy for pancreatic head cancer

胰十二指肠切除术是治疗胰头癌首选的治疗方式。胰头癌因为肿瘤部位与周围大血管比邻,易侵犯血管而导致手术切缘的R0切除率低等原因,使得腹腔镜胰十二指肠切除术(LPD)治疗胰头癌在肿瘤学疗效及生存获益等方面存在很大争议。回顾文献及临床实践证实,LPD的安全性不亚于开放胰十二指肠切除术,在R0切除率、淋巴结清扫等肿瘤学疗效方面较传统开放手术可能更有优势,其远期预后与开放手术无显著差别。胰腺癌总体发病率低、基层医院年手术量少、LPD学习曲线长是制约该术式广泛开展的主要因素。随着国内外指南与共识在胰十二指肠切除术治疗胰头癌方面的规范化和精准化,加上机器人、腹腔镜技术设备的不断进步,在大型胰腺中心,LPD有望成为治疗胰头癌的标准术式,但需在大样本、前瞻性的临床研究中进一步验证。

Surgical resection is the only curative option for pancreatic head cancer.Because the tumor site is adjacent to the surrounding large blood vessels and is easy to invade the blood vessels,the R0 resection rate of the surgical margin is low,which makes laparoscopic pancreaticoduodenectomy(LPD)in the treatment of pancreatic head cancer controversial in terms of oncological efficacy and survival benefit.Combined with literature review and clinical practice,it is confirmed that the safety of LPD is no less than that of open pancreaticoduodenectomy.LPD may have more advantages than traditional open surgery in R0 resection rate,lymph node dissection and other oncological efficacy,and its long-term prognosis is not significantly different from that of open surgery.However,the overall incidence rate of pancreatic cancer is low,and the amount of operation in primary hospitals is low per year,learning curve is long,which is the main factor restricting the wide spread of this procedure.With the standardization and accuracy of guidelines and consensus in the treatment of pancreatic head cancer,coupled with the continuous progress of robotic and laparoscopic technology and equipment,LPD is expected to become the standard precedure for the treatment of pancreatic head cancer in high volume pancreatic centers,but it needs to be further verified in large sample and prospective clinical studies.