胰腺癌伴肝脏寡转移外科治疗的再认识
Redefining the role of surgical resection in pancreatic cancer with liver oligometastases
吴鹏飞 1何进2
作者信息
- 1. 南京医科大学第一附属医院(江苏省人民医院)胰腺中心,南京 210029
- 2. 美国约翰霍普金斯大学医学院肝胆胰外科,巴尔的摩21287
- 折叠
摘要
胰腺癌恶性程度高,预后差.以外科手术为基础的综合治疗可最大程度改善胰腺癌患者的预后.但胰腺癌患者确诊时常已合并远处转移,其中以肝转移为主.大多数情况下,初诊时即转移的胰腺癌患者已失去手术机会,其标准治疗为姑息性化疗,治疗效果欠佳.近年来,随着多药联合化疗方案的实施,部分胰腺癌伴肝脏寡转移患者已通过转化手术治疗获得了生存时间的延长.然而,目前临床医师对胰腺癌伴肝脏寡转移的疾病认知仍不充分,导致其对此类患者所需的治疗方案仍不明确.笔者评述胰腺癌伴肝脏寡转移的定义,总结手术治疗的安全性和肿瘤学疗效,并从生物学可切除性角度探讨并提出具有可行性的转化手术治疗策略.
Abstract
Pancreatic cancer is an aggressive malignancy with a poor prognosis.Compre-hensive treatment based on surgical resection can improve prognosis of patients to a great extent.However,a significant challenge had arisen as patients were often diagnosed with distant metas-tases,predominantly liver metastases.Traditionally,patients presenting with metastatic pancreatic cancer have been considered unresectable,leading to palliative systemic chemotherapy as the standard treatment.With the establishment of multiagent chemotherapy protocols in recent years,the feasi-bility of conversion surgery in selected patients with liver oligometastasis following preoperative chemotherapy was reported.Nonetheless,the understanding of pancreatic cancer with liver oligo-metastases remains limited among most physicians,leaving the treatment paradigm of these patients ambiguous.In this review,the authors attempt to define liver oligometastases in pancreatic cancer,assess the safety and oncologic outcome of surgical resection,and explore feasible strategies for conversion surgery from the perspective of biological resectability.
关键词
胰腺肿瘤/肝转移/寡转移疾病/生物可切除性/转化手术/预后Key words
Pancreatic neoplasms/Liver metastases/Oligometastatic disease/Biolo-gical resectability/Conversion surgery/Prognosis引用本文复制引用
出版年
2024
NETL
NSTL
万方数据