Pancreatic Cancer: Advances in Treatment, Results and Limitations
Pancreatic Cancer: Advances in Treatment, Results and Limitations
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DOI：
10.1159/000347178
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发表时间：
2013-01-01
影响因子：
2.3
通讯作者：
Buechler, Markus W.
中科院分区：
文献类型：
--
作者：
Hackert, Thilo;Buechler, Markus W.
背景/目标：胰腺癌仍然是一个治疗挑战。手术是唯一有治愈机会的治疗方法。本综述的目的是总结目前胰腺癌最先进的外科手术。方法：回顾了有关胰腺癌手术方法的现有文献。重点放在高质量的研究、评论、系统评论和荟萃分析以及强调创新方法的招募研究上。结果：如今，在专门的大容量机构中可以进行标准切除，死亡率低于 5%。针对局部晚期癌症的扩展方法在技术上是可行的，包括静脉切除、多内脏切除和复发手术。它们可以在不增加发病率和死亡率的情况下进行，不会受到较高的 R1 或 N+ 率的影响，并且可以提高生存率。动脉肿瘤侵袭仍然存在争议，并且在肿瘤学上也存在疑问。所有手术方法都应成为跨学科多模式治疗理念的一部分，以改善患者的预后。结论：手术是治疗局限性胰腺癌的支柱。扩展方法在中心是可行的，并且除了动脉切除术外，显示出良好的长期结果。跨学科治疗是所有手术方法的重要补充。版权所有 (C) 2013 S. Karger AG，巴塞尔
Background/Aims: Pancreatic cancer remains a therapeutic challenge. Surgery is the only treatment with the chance of cure. The aim of this review is to summarize the present state-of-the-art surgical procedures in pancreatic cancer. Methods: The current literature was reviewed with regard to surgical approaches in pancreatic cancer. A focus was put on high-quality studies, reviews, systematic reviews and meta-analyses as well as recruiting studies highlighting innovative approaches. Results: Today, standard resections can be performed with mortality rates below 5% in specialized high-volume institutions. Extended approaches for locally advanced cancer are technically feasible, including venous resections, nnultivisceral resections and recurrence surgery. They can be carried out without increased morbidity and mortality, are not compromised by higher R1 or N+ rates, and can improve survival. Arterial tumor invasion is still regarded controversially and is oncologically questionable. All surgical approaches should be part of interdisciplinary multimodal treatment concepts to improve the patients' prognosis. Conclusion: Surgery is the backbone of pancreatic cancer treatment in localized disease. Extended approaches are feasible in centers and show except for arterial resections good long-term outcome. Interdisciplinary therapy is an essential supplementation of all surgical approaches. Copyright (C) 2013 S. Karger AG, Basel