Pancreatic adenocarcinoma remains the fourth leading cause of cancer-related death and is one of the most aggressive malignant tumors with an overall 5-year survival rate of less than 4%.Surgical resection remains the...Pancreatic adenocarcinoma remains the fourth leading cause of cancer-related death and is one of the most aggressive malignant tumors with an overall 5-year survival rate of less than 4%.Surgical resection remains the only potentially curative treatment but is only possible for 15%-20% of patients with pancreatic adenocarcinoma.About 40% of patients have locally advanced nonresectable disease.In the past,determination of pancreatic cancer resectability was made at surgical exploration.The development of modern imaging techniques has allowed preoperative staging of patients.Institutions disagree about the criteria used to classify patients.Vascular invasion in pancreatic cancers plays a very important role in determining treatment and prognosis.There is no evidence-based consensus on the optimal preoperative imaging assessment of patients with suspected pancreatic cancer and a unified definition ofborderline resectable pancreatic cancer is also lacking.Thus,there is much room for improvement in all aspects of treatment for pancreatic cancer.Multi-detector computed tomography has been widely accepted as the imaging technique of choice for diagnosing and staging pancreatic cancer.With improved surgical techniques and advanced perioperative management,vascular resection and reconstruction are performed more frequently;patients thought once to be unresectable are undergoing radical surgery.However,when attempting heroic surgery,a realistic approach concerning the patient's age and health status,probability of recovery after surgery,perioperative morbidity and mortality and life quality after tumor resection is necessary.展开更多
BACKGROUND： The treatment of borderline resectable pancreatic head cancer（BRPHC） is still controversial and challenging. The artery-first approaches are described to be the important options for the early determina...BACKGROUND： The treatment of borderline resectable pancreatic head cancer（BRPHC） is still controversial and challenging. The artery-first approaches are described to be the important options for the early determination. Whether these approaches can achieve an increase R0 rate, better bleeding control and increasing long-term survival for BRPHC are still controversial. We compared a previously reported technique, a modified artery-first approach（MAFA）, with conventional techniques for the surgical treatment of BRPHC.METHODS： A total of 117 patients with BRPHC undergone pancreaticoduodenectomy（PD） from January 2013 to June 2015 were included. They were divided into an MAFA group（n=78） and a conventional-technique group（n=39）. Background characteristics, operative data and complications were compared between the two groups.RESULTS： Mean operation time was significantly shorter in the MAFA group than that in the conventional-technique group（313 vs 384 min; P=0.014）; mean volume of intraoperative blood loss was significantly lower in the MAFA group than that in the conventional-technique group（534 vs 756 m L; P=0.043）; and mean rate of venous resection was significantly higher in the conventional-technique group than that in the MAFA group（61.5% vs 35.9%; P=0.014）. Pathologic data, early mortality and morbidity were not different significantly between the two groups.CONCLUSIONS： MAFA is safe, simple, less time-consuming, less intraoperative blood loss and less venous resection, and therefore, may become a standard surgical approach to PD for BRPHC with the superior mesenteric vein-portal vein involvement but without superior mesenteric artery invasion.展开更多
胰腺体尾部癌症状隐匿,恶性程度高,切除率低,预后差,整体治疗有待提高.外科手术是唯一可能治愈的手段,手术治疗为核心的多学科协作的个体化治疗策略应该成为标准模式."可能切除"患者先接受新辅助治疗,再判断是否手术有助于提...胰腺体尾部癌症状隐匿,恶性程度高,切除率低,预后差,整体治疗有待提高.外科手术是唯一可能治愈的手段,手术治疗为核心的多学科协作的个体化治疗策略应该成为标准模式."可能切除"患者先接受新辅助治疗,再判断是否手术有助于提高R0切除率,改善预后.根治性顺行胰腺体尾部癌整体切除术(radical antegrade modular pancreatosplenectomy,RAMPS)手术符合肿瘤切除原则,有望成为标准的根治手术方式.腹腔镜探查术能够发现肝转移和腹腔播散,避免不必要的开腹手术.腹腔镜下胰腺体尾部癌根治术与开腹手术相比有诸多优势,但仅限于肿瘤体积较小的早期患者,肿瘤学方面的远期效果仍需验证,建议有选择地开展.联合腹腔干切除的根治性远端胰腺癌切除术(radical distal or left pancreatectomy with resection of the celiac axis,DP-CAR)适合于肝总动脉或腹腔干受侵犯但仍有条件切除的患者,需谨慎开展.胰腺体尾部癌在早期诊断、分子水平个体化治疗方面需要突破,新辅助治疗和腹腔镜手术的开展需要进一步多中心联合前瞻实验研究提供循证证据支持.展开更多
Background:Previous studies have demonstrated the prognostic significance of pathologic tumor response in pancreatic adenocarcinoma following neoadjuvant therapy(NAT).The aim of this study was to determine the inciden...Background:Previous studies have demonstrated the prognostic significance of pathologic tumor response in pancreatic adenocarcinoma following neoadjuvant therapy(NAT).The aim of this study was to determine the incidence of significant pathologic response to NAT in borderline resectable pancreatic cancer(BRPC),and association of NAT regimen and other clinico-pathologic characteristics with pathologic response.Methods:Patients with BRPC who underwent NAT and pancreatic resection between January 2012 and June 2017 were included.Pathologic response was assessed on a qualitative scale based on the College of American Pathologists grading system.Demographics and baseline characteristics,oncologic treatment,pathology,and survival outcomes were compared.Results:Seventy-one patients were included for analysis.Four patients had complete pathologic responses(tumor regression score 0),12 patients had marked responses(score 1),42 had moderate responses(score 2),and 13 had minimal responses(score 3).Patients with complete or marked responses were more likely to have received neoadjuvant gemcitabine chemoradiation(62.5%,38.1%,and 23.1%of the complete/marked,moderate,and minimal response groups,respectively;P=0.04).Of the complete/marked,moderate,and minimal response groups,margins were negative in 75.0%,78.6%,and 46.2%(P=0.16);node negative disease was observed in 87.5%,54.8%,and 15.4%(P<0.01);and median overall survival was 50.0 months,31.7 months,and 23.2 months(P=0.563).Of the four patients with pathologic complete responses,three were disease-free at 66.1,41.7 and 31.4 months,and one was deceased with metastatic liver disease at 16.9 months.Conclusions:A more pronounced pathologic tumor response to NAT in BRPC is correlated with node negative disease,but was not associated with a statistically significant survival benefit in this study.展开更多
1文献来源研究一:Janssen QP,Buettner S,Suker M,et al.Neoadjuvant FOLFIRINOX in patients with borderline resectable pancreatic cancer:A systematic review and patient level meta analysis[J].J Natl Cancer Inst,2019,111(8)...1文献来源研究一:Janssen QP,Buettner S,Suker M,et al.Neoadjuvant FOLFIRINOX in patients with borderline resectable pancreatic cancer:A systematic review and patient level meta analysis[J].J Natl Cancer Inst,2019,111(8):782-794.研究二:Katz MH,Shi Q,Ahmad SA,et al.Preoperative modified FOLFIRINOX treatment followed by Capecitabine based chemoradiation for borderline resectable pancreatic cancer:Alliance for clinical trials in oncology trial A021101[J].JAMA Surg,2016,151(8):e161137.2证据水平1b。展开更多
BACKGROUND: Pancreatic cancer remains a devastating disease with a 5-year survival rate of less than 5%. Recent advances in diagnostic methods and therapeutic approaches have increased the possibility of improving the...BACKGROUND: Pancreatic cancer remains a devastating disease with a 5-year survival rate of less than 5%. Recent advances in diagnostic methods and therapeutic approaches have increased the possibility of improving the existing poor prognosis. DATA SOURCES: English-language articles reporting early diagnosis and therapy of pancreatic cancer were searched from the MEDLINE and PubMed databases, Chinese-language articles were from CHKD (China Hospital Knowledge Database) RESULT: The current literature about pancreatic cancer was reviewed from three aspects: statistics, screening and early detection, and therapy. CONCLUSIONS: Early detection and screening of pancreatic cancer currently should be limited to high risk patients Surgical resection is the only curative approach available, with some recent improvement in outcomes. Gemcitabine has been a standard treatment during the last decade. Gemcitabine based combination treatment, especially combined with newer molecular targeted agents, is promising. The rationale for radiotherapy is controversial, but with the recent development of modern radiation delivery techniques, radiotherapy should be intensified. Patients with borderline pancreatic cancer could benefit from neoadjuvant therapy but more evidence is needed and the best neoadjuvant regimen is still to be determined.展开更多
文摘Pancreatic adenocarcinoma remains the fourth leading cause of cancer-related death and is one of the most aggressive malignant tumors with an overall 5-year survival rate of less than 4%.Surgical resection remains the only potentially curative treatment but is only possible for 15%-20% of patients with pancreatic adenocarcinoma.About 40% of patients have locally advanced nonresectable disease.In the past,determination of pancreatic cancer resectability was made at surgical exploration.The development of modern imaging techniques has allowed preoperative staging of patients.Institutions disagree about the criteria used to classify patients.Vascular invasion in pancreatic cancers plays a very important role in determining treatment and prognosis.There is no evidence-based consensus on the optimal preoperative imaging assessment of patients with suspected pancreatic cancer and a unified definition ofborderline resectable pancreatic cancer is also lacking.Thus,there is much room for improvement in all aspects of treatment for pancreatic cancer.Multi-detector computed tomography has been widely accepted as the imaging technique of choice for diagnosing and staging pancreatic cancer.With improved surgical techniques and advanced perioperative management,vascular resection and reconstruction are performed more frequently;patients thought once to be unresectable are undergoing radical surgery.However,when attempting heroic surgery,a realistic approach concerning the patient's age and health status,probability of recovery after surgery,perioperative morbidity and mortality and life quality after tumor resection is necessary.
基金supported by grants from The National Natural Science Foundation of China(81071775,81272659,81101621,81172064,81001068 and 81272425)Key Projects of Science Foundation of Hubei Province(2011CDA030)Research Fund of Young Scholars for the Doctoral Program of Higher Education of China(20110142120014)
文摘BACKGROUND： The treatment of borderline resectable pancreatic head cancer（BRPHC） is still controversial and challenging. The artery-first approaches are described to be the important options for the early determination. Whether these approaches can achieve an increase R0 rate, better bleeding control and increasing long-term survival for BRPHC are still controversial. We compared a previously reported technique, a modified artery-first approach（MAFA）, with conventional techniques for the surgical treatment of BRPHC.METHODS： A total of 117 patients with BRPHC undergone pancreaticoduodenectomy（PD） from January 2013 to June 2015 were included. They were divided into an MAFA group（n=78） and a conventional-technique group（n=39）. Background characteristics, operative data and complications were compared between the two groups.RESULTS： Mean operation time was significantly shorter in the MAFA group than that in the conventional-technique group（313 vs 384 min; P=0.014）; mean volume of intraoperative blood loss was significantly lower in the MAFA group than that in the conventional-technique group（534 vs 756 m L; P=0.043）; and mean rate of venous resection was significantly higher in the conventional-technique group than that in the MAFA group（61.5% vs 35.9%; P=0.014）. Pathologic data, early mortality and morbidity were not different significantly between the two groups.CONCLUSIONS： MAFA is safe, simple, less time-consuming, less intraoperative blood loss and less venous resection, and therefore, may become a standard surgical approach to PD for BRPHC with the superior mesenteric vein-portal vein involvement but without superior mesenteric artery invasion.
文摘胰腺体尾部癌症状隐匿,恶性程度高,切除率低,预后差,整体治疗有待提高.外科手术是唯一可能治愈的手段,手术治疗为核心的多学科协作的个体化治疗策略应该成为标准模式."可能切除"患者先接受新辅助治疗,再判断是否手术有助于提高R0切除率,改善预后.根治性顺行胰腺体尾部癌整体切除术(radical antegrade modular pancreatosplenectomy,RAMPS)手术符合肿瘤切除原则,有望成为标准的根治手术方式.腹腔镜探查术能够发现肝转移和腹腔播散,避免不必要的开腹手术.腹腔镜下胰腺体尾部癌根治术与开腹手术相比有诸多优势,但仅限于肿瘤体积较小的早期患者,肿瘤学方面的远期效果仍需验证,建议有选择地开展.联合腹腔干切除的根治性远端胰腺癌切除术(radical distal or left pancreatectomy with resection of the celiac axis,DP-CAR)适合于肝总动脉或腹腔干受侵犯但仍有条件切除的患者,需谨慎开展.胰腺体尾部癌在早期诊断、分子水平个体化治疗方面需要突破,新辅助治疗和腹腔镜手术的开展需要进一步多中心联合前瞻实验研究提供循证证据支持.
文摘Background:Previous studies have demonstrated the prognostic significance of pathologic tumor response in pancreatic adenocarcinoma following neoadjuvant therapy(NAT).The aim of this study was to determine the incidence of significant pathologic response to NAT in borderline resectable pancreatic cancer(BRPC),and association of NAT regimen and other clinico-pathologic characteristics with pathologic response.Methods:Patients with BRPC who underwent NAT and pancreatic resection between January 2012 and June 2017 were included.Pathologic response was assessed on a qualitative scale based on the College of American Pathologists grading system.Demographics and baseline characteristics,oncologic treatment,pathology,and survival outcomes were compared.Results:Seventy-one patients were included for analysis.Four patients had complete pathologic responses(tumor regression score 0),12 patients had marked responses(score 1),42 had moderate responses(score 2),and 13 had minimal responses(score 3).Patients with complete or marked responses were more likely to have received neoadjuvant gemcitabine chemoradiation(62.5%,38.1%,and 23.1%of the complete/marked,moderate,and minimal response groups,respectively;P=0.04).Of the complete/marked,moderate,and minimal response groups,margins were negative in 75.0%,78.6%,and 46.2%(P=0.16);node negative disease was observed in 87.5%,54.8%,and 15.4%(P<0.01);and median overall survival was 50.0 months,31.7 months,and 23.2 months(P=0.563).Of the four patients with pathologic complete responses,three were disease-free at 66.1,41.7 and 31.4 months,and one was deceased with metastatic liver disease at 16.9 months.Conclusions:A more pronounced pathologic tumor response to NAT in BRPC is correlated with node negative disease,but was not associated with a statistically significant survival benefit in this study.
文摘1文献来源研究一:Janssen QP,Buettner S,Suker M,et al.Neoadjuvant FOLFIRINOX in patients with borderline resectable pancreatic cancer:A systematic review and patient level meta analysis[J].J Natl Cancer Inst,2019,111(8):782-794.研究二:Katz MH,Shi Q,Ahmad SA,et al.Preoperative modified FOLFIRINOX treatment followed by Capecitabine based chemoradiation for borderline resectable pancreatic cancer:Alliance for clinical trials in oncology trial A021101[J].JAMA Surg,2016,151(8):e161137.2证据水平1b。
文摘BACKGROUND: Pancreatic cancer remains a devastating disease with a 5-year survival rate of less than 5%. Recent advances in diagnostic methods and therapeutic approaches have increased the possibility of improving the existing poor prognosis. DATA SOURCES: English-language articles reporting early diagnosis and therapy of pancreatic cancer were searched from the MEDLINE and PubMed databases, Chinese-language articles were from CHKD (China Hospital Knowledge Database) RESULT: The current literature about pancreatic cancer was reviewed from three aspects: statistics, screening and early detection, and therapy. CONCLUSIONS: Early detection and screening of pancreatic cancer currently should be limited to high risk patients Surgical resection is the only curative approach available, with some recent improvement in outcomes. Gemcitabine has been a standard treatment during the last decade. Gemcitabine based combination treatment, especially combined with newer molecular targeted agents, is promising. The rationale for radiotherapy is controversial, but with the recent development of modern radiation delivery techniques, radiotherapy should be intensified. Patients with borderline pancreatic cancer could benefit from neoadjuvant therapy but more evidence is needed and the best neoadjuvant regimen is still to be determined.
