Pancreatic cancer can arise from either the exocrine or endocrine cells. Cancer of the endocrine pancreas, also known as pancreatic neuroendocrine tumor, is uncommon and has a relatively better prognosis than pancreatic adenocarcinoma (cancer of the exocrine pancreas). In the United States, approximately 48960 people are diagnosed with cancer of the exocrine pancreas each year, and an estimated 40560 people will die from their disease; it is the fourth leading cause of cancer mortality in men and women[1]. Globally, it is the seventh leading cause of cancer mortality in men and women, causing more than 300000 deaths annually[2]. Most patients with pancreatic adenocarcinoma will die within two years of diagnosis, and the 5-year survival rate is less than 5%[3]. The lack of a low cost screening test with high sensitivity and specificity contributes to most cases being diagnosed at an advanced stage. Staging of pancreatic adenocarcinoma is usually done with tri-phasic pancreatic-protocol computed tomography scan of abdomen and pelvis and chest imaging. Based upon imaging, the tumor is classified as resectable, borderline resectable, locally advanced, or metastatic. Approximately 15% to 20% of patients are diagnosed with resectable disease and 45%-55% of patients are diagnosed with metastatic disease[4]. Appropriate staging allows the selection of patients who will have the best chance for curative intent resection (R0). Patients with borderline resectable disease are often given neoadjuvant treatment for tumor downstaging to render resection afterwards. Up to about onethird of patients with borderline-resectable tumors could have resectable disease after neoadjuvant treatment[5]. However, the role of neoadjuvant treatment for resectable pancreatic cancer remains unclear. Surgical resection remains the only curative treatment for pancreatic cancer. A tumor is considered resectable if there is no arterial tumor contact [celiac axis (CA), superior mesenteric artery (SMA), common hepatic artery] and there is no tumor contact with the superior mesenteric vein (SMV) or portal vein (PV) or ≤ 180-degrees contact without vein contour irregularity on imaging study[6]. A tumor is considered unresectable if there is distant metastasis or unreconstructible SMV/PV due to tumor; if the tumor involves the pancreatic head it is unresectable if there is more than 180-degree encasement of the SMA or CA; a tumor of the pancreatic body or tail is unresectable if there is more than 180-degree encasement of the SMA or CA or tumor contact with the CA and aortic involvement[6].
Surgical management may include pancreaticoduodenectomy or pancreatectomy. It has been shown that pancreatic cancer patients undergoing surgery have better outcomes at high-volume hospitals, and the multidisciplinary approach and experienced surgeon seem to contribute most to the outcome of patients receiving pancreatic surgery[7]. The incomplete resection with positive surgical margins is frequent, reported 40% to 50% in most series[8]. The survival rate for patients with positive surgical margins is similar to that of patients who have locally-advanced disease[9]. The long-term survival after surgery remains low due to high rate of systemic recurrence: About 10% for node-positive disease and about 25% to 30% for nodenegative disease[10-13]. Adjuvant treatment has been shown to improve survival as demonstrated in studies such as ESPAC-1, CONKO-001, ESPAC-3, RTOG 9704, and GITSG[14]. However, the delivery of postoperative treatment can be problematic with up to 50% of patients not receiving the intended treatment due to postoperative complications[15,16]. About 15% of patients may develop overt metastatic disease during postoperative recovery period, therefore early initiation of adjuvant chemotherapy within 20 d after surgery has been shown to improve disease-free and overall survival[8,17].
胰腺癌患者可以出现从外分泌或内分泌细胞。癌症的胰腺内分泌,也被称为胰腺神经内分泌肿瘤,为罕见,预后相对较好,胰腺腺癌 (胰腺外分泌癌症)。在美国,大约有 48960 人被诊断为癌症的胰腺外分泌每年和估计 40560 人将死于他们的疾病;它是癌症死亡率在男性和女性 [1] 的第四个主要原因。就全球而言,它是癌症死亡率在男性和女性,造成超过 300000 人死亡每年 [2] 的第七个主要原因。大多数患者胰腺腺癌的诊断,两年内会死和 5 年生存率是小于 5%[3]。低成本甄别试验具有较高的灵敏度和特异性的缺乏导致了大多数情况下,被诊断出晚期。胰腺癌分期通常是与三阶段性胰腺协议进行计算机断层扫描的腹部和骨盆及胸部影像学。基于成像,肿瘤被归类为手术切除,切除、 局部晚期或转移性的界线。大约有 15%到 20%的患者在诊断时可切除性疾病和 45%-55%的患者被诊断为转移性疾病 [4]。适当转移允许选择的病人会有意向根治 (R0) 的最好机会。交界性切除病患者往往给出肿瘤之呈现切除之后的新辅助治疗。达约三分之一的边缘切除肿瘤患者可以有可切除性疾病后新辅助治疗 [5]。然而,切除胰脏癌的新辅助治疗的作用仍不清楚。手术切除仍是唯一的治疗胰腺癌。如果没有动脉肿瘤接触 [腹腔轴 (CA),肠系膜上动脉 (SMA),肝总动脉] 并没有肿瘤接触与肠系膜上静脉 (SMV) 或门静脉 (PV) 或 ≤ 180 度联系人没有静脉成像研究 [6] 的轮廓不规则,肿瘤被视为可切除性。肿瘤被认为是不能手术切除是否有远处转移或冥顽 SMV/光伏肿瘤;如果涉及到是否比 180 度装箱的 SMA 或 CA; 更是一个不能切除的胰头肿瘤肿瘤的胰体或尾巴是不能切除,如果还有更多比 180 度装箱的 SMA 或 CA 或肿瘤的联系人的 CA 和主动脉参与 [6]。Surgical management may include pancreaticoduodenectomy or pancreatectomy. It has been shown that pancreatic cancer patients undergoing surgery have better outcomes at high-volume hospitals, and the multidisciplinary approach and experienced surgeon seem to contribute most to the outcome of patients receiving pancreatic surgery[7]. The incomplete resection with positive surgical margins is frequent, reported 40% to 50% in most series[8]. The survival rate for patients with positive surgical margins is similar to that of patients who have locally-advanced disease[9]. The long-term survival after surgery remains low due to high rate of systemic recurrence: About 10% for node-positive disease and about 25% to 30% for nodenegative disease[10-13]. Adjuvant treatment has been shown to improve survival as demonstrated in studies such as ESPAC-1, CONKO-001, ESPAC-3, RTOG 9704, and GITSG[14]. However, the delivery of postoperative treatment can be problematic with up to 50% of patients not receiving the intended treatment due to postoperative complications[15,16]. About 15% of patients may develop overt metastatic disease during postoperative recovery period, therefore early initiation of adjuvant chemotherapy within 20 d after surgery has been shown to improve disease-free and overall survival[8,17].
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