胰臟癌之外科治療

Surgical Management of Pancreatic Cancer

近代對於胰臟癌的治療有長足的進步，手術切除目前仍是唯一有機會治癒的方式，透過分析術後復發的危險因子，且在手術技巧及術後照顧大幅進步的前提之下，讓具安全性的胰臟手術更能增進病患存活率的方式就是增加切除率，在術前可以透過影像學檢查依據腫瘤與週邊重要動靜脈的關係將病患區分為可切除、不確定可切除、不可切除和轉移等四類。目前的證據顯示系統性的切除胰腸繫膜、神經叢、以及淋巴的廓清包含局部以及主動脈周邊以達到腫瘤切除乾淨後再加上術後輔助化學治療才有利於長期存活。至於新輔助治療用於非可切除的胰臟癌以期降階可再切除被寄與厚望，然需在切除性判斷標準、治療處方、治療成效評估、評估轉換手術可能性、以及病理對於切除性標準仍須取得共識。

Even the advancement of state-of-art treatment for pancreatic cancer, surgical resection remains the only potentially curative policy. The safety of pancreatectomy have improved greatly based on advanced surgical technique and dedicated postoperative care, the mortality of Whipple operation is about 2%. To improve the overall survival, what we can do is to attain the radicality. Radiologically, the pancreatic cancers are categorized into resectable, borderline resectable, unresectable, and metastatic according to the relationship of the neoplasm with adjacent vessels. Otherwise, systematic masopancreas and mesojejunum dissection for nerve plexus eradication along with regional and para-aortic lymphnode dissection have the tendency to achieve R0 resection. The subsequent adjuvant therapy shows improved overall survival. Furthermore, neoadjuvant therapy is expected to downstage those cannot be resected. However, consensus in radiological resectibility, regimen and sequence, assessment of the efficacy or effectiveness, evaluation of conversion surgery, and histopathological radicality is necessary to improve patient survival.