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重视胰腺癌微创手术的肿瘤学原则

Emphasizing Principles of Surgical Oncology in Minimally Invasive Surgery for Pancreatic Cancer

  • 摘要: 手术切除迄今为止仍是胰腺癌唯一的潜在根治手段,但胰腺癌手术也是所有恶性肿瘤手术中围手术期风险最高、远期预后最差的手术之一,这对外科医生形成了巨大挑战。近年来,胰腺手术在高流量中心的集中化、手术技术的进步以及围手术期管理水平的提高等显著降低了胰腺手术的围手术期并发症发生率与死亡率,同时外科医生也开始尝试将腹腔镜以及机器人辅助手术等微创手段应用于胰腺癌根治术,以期降低手术对患者造成的创伤,进一步加速患者康复,提高患者的生活质量。已有多项研究对比了微创胰腺切除手术与传统开放手术的围手术期安全性,证实了微创胰腺切除手术的技术可行性,但微创手术对胰腺癌患者远期预后影响的研究仍然较少,胰腺癌根治术是否适合以微创的方式完成也仍存争议。因此,外科医生在对胰腺癌实施微创手术时应遵循整块切除与非接触等肿瘤学原则,并且应开展更多的对照研究来明确胰腺癌微创手术是否能使患者在长期生存方面获益。通过本综述,一方面希望能客观评价微创技术在胰腺癌根治术中的价值,另一方面也希望能尽量避免为了微创而微创、为了微创而违反肿瘤学原则现象的发生。

     

    Abstract: Surgical resection remains the only potentially curative treatment for pancreatic cancer to date. However, pancreatic cancer surgery is also one of procedures carrying the highest risks among all malignant tumor surgeries, in terms of perioperative complications and long-term prognosis, posing a significant challenge to surgeons. In recent years, the centralization of pancreatic surgery in high-volume centers, advancements in surgical techniques, and improvements in perioperative management of pancreatic cancer resection have significantly reduced the incidence of perioperative complications and mortality. In addition, surgeons have begun exploring minimally invasive approaches, such as laparoscopic and robot-assisted surgeries, for radical resection of pancreatic cancer, aiming to reduce surgical trauma, accelerate patient recovery, and improve quality of life. The technical feasibility of minimally invasive approaches has been validated in multiple studies through comparisons of the perioperative safety of minimally invasive pancreatic resection with that of conventional open surgery. However, research on the long-term oncologic prognosis of minimally invasive surgery for pancreatic cancer remains limited, and controversy persists regarding the suitability of minimally invasive methods for radical resection of pancreatic cancer. Therefore, surgeons should adhere to the fundamental principles of surgical oncology, including en bloc resection and the no-touch isolation technique, when they perform minimally invasive pancreatic cancer surgery. Additionally, more comparative studies are warranted to determine whether minimally invasive pancreatic cancer surgery offers survival benefits in the long term. This review aims to provide an objective evaluation of the role of minimally invasive techniques in radical resection of pancreatic cancer, while cautioning against compromising the principles of surgical oncology in the pursuit of minimally invasive approaches.

     

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