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首页> 外文会议>St. Gallen EORTC Gastrointestinal Cancer Conference >Pancreatic surgery: beyond the traditional limits.
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Pancreatic surgery: beyond the traditional limits.

机译：胰腺手术：超越传统限制。

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Pancreatic cancer is one of the five leading causes of cancer death for both males and females in the western world. More than 85 % pancreatic tumors are of ductal origin but the incidence of cystic tumors such as intrapapillary mucinous tumors (IPMN) or mucinous cystic tumors (MCN) and other rare tumors is rising. Complete surgical resection of the tumor is the mainstay of any curative therapeutic approach, however, up to 40 % of patients with potentially resectable pancreatic cancer are not offered surgery. This is despite 5-year survival rates of up to 40 % or even higher in selected patients depending on tumor stage and histology. Standard procedures for pancreatic tumors include the Kausch-Whipple- or pylorus-preserving Whipple procedure, and the left lateral pancreatic resection (often with splenectomy), and usually include regional lymphadenectomy. More radical or extended pancreatic operations are becoming increasingly utilised however and we examine the data available for their role. These operations include major venous and arterial resection, multivisceral resections and surgery for metastatic disease, or palliative pancreatic resection. Portal vein resection for local infiltration with or without replacement graft is now well established and does not deleteriously affect perioperative morbidity or mortality. Arterial resection, however, though often technically feasible, has questionable oncologic impact, is not without risk and is usually reserved for isolated cases. The value of extended lymphadenectomy is frequently debated; the recent level I evidence demonstrates no advantage. Multivisceral resections, i.e. tumors, often in the tail of the pancreas, with invasion of the colon or stomach or other surrounding tissues, while associated with an increased morbidity and a longer hospital stay, do however show comparable mortality-and survival rates to those without such infiltration and therefore should be performed if technically feasible. Routine resection for metastatic disease however does not seem to show any advantage over palliative treatment but may be an option in selected patients with easily removable metastases. In conclusion pancreatic surgery beyond the traditional limits is established in tumors infiltration the venous system and may be a considered approach in selected patients with locally infiltrating pancreatic cancer or metastasis.
机译：胰腺癌是西方男性和女性的癌症死亡的五个主要原因之一。超过85％的胰腺肿瘤具有导管来源，但囊性肿瘤如腺嘌呤粘液肿瘤（IPMN）或粘液囊性肿瘤（MCN）和其他罕见的肿瘤的发生率正在上升。完全手术切除肿瘤是任何疗法治疗方法的支柱，但最多40％的患者患有潜在可重置的胰腺癌患者手术。根据肿瘤阶段和组织学，选择患者在选定的患者中的5年生存率高达40％甚至更高。胰腺肿瘤的标准程序包括Kausch-Whipple或Pylorus保存的乳剂程序，以及左侧胰切除（通常具有脾切除术），通常包括区域淋巴结切除术。然而，更多的激进或延长的胰腺作业越来越多地利用，并且我们检查了可用于其角色的数据。这些作业包括主要的静脉和动脉切除，多聚念珠切除和转移性疾病的手术，或姑息性胰腺切除。目前有或没有替换移植物的局部渗透的门静脉切除，并且不会有害地影响围手术期的发病率或死亡率。然而，动脉切除术，但经常在技术上可行，具有可疑的肿瘤影响，并非没有风险，通常保留用于孤立的病例。延长淋巴结切除术的价值经常讨论;最近的一级证据证明了没有任何优势。多抗民分裂，即肿瘤，通常在胰腺的尾部，随着肠道或胃或其他周围组织的侵袭，同时与发病率增加和较长的住院住院，但是为那些没有持续的医院停留而表现出可比的死亡率和生存率这种渗透，因此应该在技术上可行的情况下进行。然而，用于转移性疾病的常规切除似乎似乎在姑息治疗中显示出任何优势，但可以是易于可拆卸转移的选定患者的选项。结论胰腺外科除了传统限制之外的肿瘤浸润建立静脉系统，可能是局部渗透胰腺癌或转移的选定患者中的考虑方法。

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