PDF(Pubmed)
Abstract：
Pancreatic ductal adenocarcinoma (PDAC) remains associated with poor outcomes with a 5-year survival of 12% across all stages of the disease. These poor outcomes are driven by a delay in diagnosis and an early propensity for systemic dissemination of the disease. Recently, aggressive surgical approaches involving complex vascular resections and reconstructions have become more common, thus allowing more locally advanced tumors to be resected. Unfortunately, however, even after the completion of surgery and systemic therapy, approximately 40% of patients experience early recurrence of disease. To determine resectability, many institutions utilize anatomical staging systems based on the presence and extent of vascular involvement of major abdominal vessels around the pancreas. However, these classification systems are based on anatomical considerations only and do not factor in the burden of systemic disease. By integrating the biological criteria, we possibly could avoid futile resections often associated with significant morbidity. Especially patients with anatomically resectable disease who have a heavy burden of radiologically undetected systemic disease most likely do not derive a survival benefit from resection. On the contrary, we could offer complex resections to those who have locally advanced or oligometastatic disease but have favorable systemic biology and are most likely to benefit from resection. This review summarizes the current literature on defining anatomical and biological resectability in patients with pancreatic cancer.
摘要：
胰腺导管腺癌（PDAC）仍然与不良预后相关，在疾病的所有阶段中，5年生存率为12％。这些不良结果是由诊断延迟和疾病全身传播的早期倾向驱动的。最近,涉及复杂血管切除和重建的积极手术方法变得越来越普遍，从而允许切除更多的局部晚期肿瘤。不幸的是,然而,即使在手术和全身治疗完成后，约40%的患者出现疾病早期复发.为了确定可切除性，许多机构利用基于胰腺周围主要腹部血管的血管受累的存在和程度的解剖分期系统。然而,这些分类系统仅基于解剖学方面的考虑,不考虑全身性疾病的负担.通过整合生物学标准，我们有可能避免通常与显著发病率相关的徒劳切除。尤其是具有解剖学可切除疾病的患者，其放射学上未发现的全身性疾病的负担很重，很可能无法从切除中获得生存益处。相反,我们可以为那些患有局部晚期或寡转移疾病但具有良好的系统生物学特性并且最有可能从切除中受益的患者提供复杂的切除。这篇综述总结了目前有关胰腺癌患者解剖和生物学可切除性定义的文献。
