摘要
胰腺癌新辅助化疗在临床应用愈加广泛。对于新辅助化疗后病人,腹腔镜胰十二指肠切除术是否安全有效,尚无研究。胰腺癌新辅助化疗后,肿瘤局部纤维结缔组织的炎症会导致缺乏良好组织间隙,解剖分离困难,因此微创手术的难点在于切除过程,而重建相对固定且成熟,很少会受到新辅助化疗的影响。新辅助化疗后,影像学评估肿瘤退缩效果往往不明显,更多的在于对肿瘤标记物等反应肿瘤生物学指标的控制。手术合并血管切除重建的比例相对较高,但得益于3D腹腔镜高清晰度和放大的手术视野,有利受侵犯血管的切除和重建。新辅助化疗后腹腔镜胰十二指肠切除术与开放手术相比,长期生存率是否存在差异,尚需前瞻性、大样本、多中心随机对照临床试验加以验证。
Neoadjuvant chemotherapy is widely used in pancreatic cancer.Whether laparoscopic pancreaticoduodenectomy is safe and effective for pancreatic cancer patients after neoadjuvant chemotherapy has not been studied.After neoadjuvant chemotherapy,the inflammation of the fibrous connective tissue in the tumor may lead to a lack of good tissue gap and difficult dissection.Therefore,the difficulty of minimally invasive surgery is the resection process,while the reconstruction is relatively fixed and mature,and is rarely affected by neoadjuvant chemotherapy.After neoadjuvant chemotherapy,the tumor regression evaluated by imaging is not obvious,while the control of tumor biological indicators such as tumor markers is more important.The proportion of vascular resection and reconstruction is relatively high.However,with the high-definition and enlarged surgical field of 3D laparoscopy,the resection and reconstruction of the invaded vessels will no longer be difficult.Whether the long-term prognosis of laparoscopic pancreatoduodenectomy after neoadjuvant chemotherapy is different from that of open surgery needs to be verified by prospective,large sample,and multi center randomized controlled clinical trials.
作者
李征
虞先濬
徐晓武
LI Zheng;YU Xian-jun;XU Xiao-wu(Department of Pancreatic Surgery,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai Pancreatic Cancer Institute,Pancreatic Cancer Institute,Fudan University,Shanghai 200032,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2022年第5期526-528,共3页
Chinese Journal of Practical Surgery
基金
上海市卫生健康委员会卓越项目(No.20224Z0006)
上海市抗癌协会雏鹰计划(No.SACACY21C11)
上海市科技重大专项(No.21JC1401500)
上海市教委科技创新项目(No.2019-01-07-00-07-E00057)
上海医院发展中心临床研究计划(No.SHDC2020CR1006A)。
关键词
胰腺癌
新辅助化疗
微创手术
并发症
预后
pancreatic cancer
neoadjuvant chemotherapy
minimally invasive surgery
complication
prognosis
作者简介
通信作者:徐晓武,E-mail:xuxiaowu@fudanpci.org。
