局部晚期胰腺癌新辅助化疗后合并血管切除相关问题

Related problems of locally advanced pancreatic cancer after neoadjuvant chemotherapy combined with vascular resection

局部晚期胰腺癌一般由于侵犯邻近主要血管、淋巴管浸润和沿神经鞘侵袭性生长被认为无法手术根治。近年来,新辅助治疗为该类病人提供了更多获得根治性切除的可能,但同时也增加了肿瘤局部纤维结缔组织发生炎症的风险,并导致缺乏良好组织间隙,增加手术难度。充分全面的术前评估是手术安全进行的前提,动脉优先入路的应用,腹腔干、肠系膜上动脉和门静脉之间的解剖三角(即海德堡三角)的清扫以及根治性顺行模块化胰脾切除术的开展,提高肿瘤切除的完整性的同时,降低了局部复发的风险。手术技术的进步以及联合血管切除重建的广泛开展,使新辅助化疗后局部晚期胰腺癌病人获得长期生存的可能增加。

Locally advanced pancreatic cancer is generally considered initially unresectable due to invasion of adjacent major blood vessels,invasion of lymphatic and aggressive local growth along nerve sheath tissue.In recent years,neoadjuvant therapy provided more opportunities of radical resection for those patients.However,neoadjuvant therapy can lead to increased risk of inflammation of local fibrous connective tissue in the tumor,which can lead to lack of good tissue gaps and increase the difficulty of surgery.Therefore,a comprehensive preoperative evaluation is a prerequisite for safe surgery,while different artery-first approaches,dissection of the anatomical triangle between the coeliac,superior mesenteric arteries and the portomesenteric vein,and radical antegrade modular pancreatosplenectomy are introduced to enhance the completeness of resection and reduce the risk of local recurrence.The advancement of surgical techniques and the wide application of vascular resection and/or reconstruction make it possible for patients with LAPC after neoadjuvant chemotherapy to achieve long-term prognosis.