摘要
Введение. Более чем у половины больных раком головки поджелудочной железы (РГПЖ) на момент постановки диагноза имеется местнораспространенная опухоль и/или отдаленные гематогенные метастазы. Таким образом, прогноз у большинства таких пациентов неблагоприятный, с 5-летней выживаемостью 8% на всех стадиях. Текущее десятилетие стало свидетелем бурной эволюции в хирургии поджелудочной железы, в частности, по сравнению с классическим подходом к панкреатодуоденальной резекции (ПДР) стали появляться альтернативные варианты, такие как Artery-first approach, Total Mesopancreas Excision (TMpE), No-touch approach ― все перечисленные методы своей главной целью ставят повышение резектабильности, частоты выполнения R0-резекции и улучшение отдаленных онкологических результатов. На основании проанализированной литературы мы пришли к выводу, что увеличение объема оперативного вмешательства у больных раком поджелудочной железы не улучшает онкологические результаты. Расширенная лимфодиссекция не продемонстрировала преимуществ в метаанализах. Отсутствуют исследования, доказывающие эффективность и целесообразность выполнения мезопанкреасэктомии.
参考
Carioli G, Bertuccio P, Boffetta P et al. European cancer mortality predictions for the year 2020 with a focus on prostate cancer // Annals of Oncology. Elsevier Ltd. 2020;31(5):650–658.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020 // CA: A Cancer Journal for Clinicians. Wiley 2020;70(1):7–30.
Griffin JF, Poruk KE, Wolfgang CL. Pancreatic cancer surgery: Past, present, and future // Chinese Journal of Cancer Research. AME Publishing Company, 2015;27(4):332–348.
Skandalakis LJ, Rowe JSJr, Gray SW et al. Surgical embryology and anatomy of the pancreas // Surgical Clinics of North America. 1993;73(4):661–697.
Henry BM, Skinningsrud B, Saganiak K et al. Development of the human pancreas and its vasculature ― An integrated review covering anatomical, embryological, histological, and molecular aspects // Annals of Anatomy. Elsevier GmbH. 2019;221:115–124.
Kitagawa H, Tajima H, Nakagawara H et al. The retropancreatic fusion fascia acts as a barrier against infiltration by pancreatic carcinoma // Molecular and Clinical Oncology. Spandidos Publications. 2013;1(3):418–422.
Reich P, Schreiber HW, Lierse W et al. Archiv Chirurgie: Mesoduodenum // Langenbecks Arch Chir. 1988;373:182–188.
Cho BH, Kimura W, Song et al. An investigation of the embryologic development of the fascia used as the basis for pancreaticoduodenal mobilization // Journal of Hepato-Biliary-Pancreatic Surgery. 2009;16(6):824–831.
Nagakawa Y, Yi SQ, Takishita C et al. Precise anatomical resection based on structures of nerve and fibrous tissue around the superior mesenteric artery for mesopancreas dissection in pancreaticoduodenectomy for pancreatic cancer // Journal of Hepato-Biliary-Pancreatic Sciences // Blackwell Publishing Asia. 2020;27(6):342–351.
Ishikawa O, Ohhigashi H, Sasaki Y et al. Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head // Ann Surg. 1988;208(2):215–220. doi:10.1097/00000658-198808000-00014
Borghi F, Gattolin A, Garbossa D et al. Embryologic Bases of Extended Radical Resection in Pancreatic Cancer.
Nagai H. An anatomical and pathological study of autopsy material on metastasis of pancreatic cancer to para-aortic lymph nodes // Jpn J Surg. 1987;88:308–317.
Gockel I, Domeyer M, Wolloscheck T et al. Resection of the mesopancreas (RMP): A new surgical classification of a known anatomical space // World Journal of Surgical Oncology. 2007;5.
Agrawal MK, Thakur DS, Somashekar U et al. Mesopancreas: myth or reality? // JOP. Journal of the Pancreas. 2010;11, № 3:230–233.
Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery ― the clue to pelvic recurrence? // The British journal of surgery. 69(10):613–616. doi:10.1002/bjs.1800691019.
Peparini N, Caronna R, Chirletti P. The «meso» of the rectum and the «meso» of the pancreas: Similar terms but distinct concepts in surgical oncology // Hepatobiliary and Pancreatic Diseases International. Elsevier (Singapore) Pte Ltd. 2015;14(5):548–551.
Sharma D, Isaji S. Mesopancreas is a misnomer: time to correct the nomenclature // Journal of Hepato-Biliary-Pancreatic Sciences. Blackwell Publishing Asia. 2016;23(12):745–749.
Inoue Y, Saiura A, Yoshioka R et al. Pancreatoduodenectomy with systematic mesopancreas dissection using a supracolic anterior artery-first approach // Annals of Surgery. Lippincott Williams and Wilkins. 2015;262(6):1092–1101.
Ramia JM, De-la-Plaza R, Manuel-Vazquez A et al. Systematic review of the mesopancreas: concept and clinical implications // Clinical and Translational Oncology. Springer-Verlag Italia s.r.l. 2018;20(11):1385–1391.
Ramia JM, De-la-Plaza R, Manuel-Vazquez A et al. Intestinal derotation procedure for facilitating pancreatoduodenectomy // Surgery (United States). Mosby Inc. 2016;159(5):1325–1332.
Quero G, Fiorillo C, Menghi R et al. Total mesopancreas excision for periampullary malignancy: a single-center propensity score-matched comparison of long-term outcomes // Langenbeck’s Archives of Surgery. Springer. 2020;405(3):303–312.
Yoshioka H, Wakabayashi T. Therapeutic Neurotomy on Head of Pancreas for Relief of Pain Due to Chronic Pancreatitis // A.M.A. Archives of Surgery. 1958;76(4).
Kayahara M, Nagakawa T, Futagami F et al. Lymphatic flow and neural plexus invasion associated with carcinoma of the body and tail of the pancreas // Cancer. 1996;78:2485–2491.
Yi SQ, Shimokawa T, Akita K et al. Anatomical Study of the Pancreas in the House Musk Shrew (Suncus murinus), with Special Reference to the Blood Supply and Innervation // Anatomical Record ― Part A Discoveries in Molecular, Cellular, and Evolutionary Biology. Wiley-Liss Inc. 2003;273(1):630–635.
Yi SQ, Miwa K, Ohta T et al. Innervation of the Pancreas from the Perspective of Perineural Invasion of Pancreatic Cancer. 2003.
Kondo S. Japanese Pancreas Society Staging Systems for Pancreatic Cancer // Pancreatic Cancer. Springer New York. 2010:1035–1050.
Isaji S, Murata Y, Kishiwada M. New Japanese classification of pancreatic cancer // Pancreatic Cancer. Springer New York. 2018:1021–1037.
Nagakawa T, Konishi I, Higashino Y et al. The spread and prognosis of carcinoma in the region of the pancreatic head // The Japanese Journal of Surgery. 1989;19(5).
Makino I, Kitagawa H, Ohta T et al. Nerve Plexus Invasion in Pancreatic Cancer Spread Patterns on Histopathologic and Embryological Analyses // Pancreas &. 2008;37(4).
Mochizuki K, Gabata T, Kozaka K et al. MDCT findings of extrapancreatic nerve plexus invasion by pancreas head carcinoma: Correlation with en bloc pathological specimens and diagnostic accuracy // European Radiology. 2010;20(7):1757–1767.
Chang DK, Johns AL, Merrett ND et al. Margin Clearance and Outcome in Resected Pancreatic Cancer // Journal of Clinical Oncology. 2009;27(17):2855–2862.
Varadhachary GR, Tamm EP, Abbruzzese JL et al. Borderline resectable pancreatic cancer: Definitions, management, and role of preoperative therapy // Annals of Surgical Oncology. 2006;13(8):1035–1046.
Hishinuma S, Ogata Y, Tomikawa M et al. Patterns of Recurrence After Curative Resection of Pancreatic Cancer, Based on Autopsy Findings // Journal of Gastrointestinal Surgery. 2006;10(4):511–518.
Weitz J, Rahbari N, Koch M et al. The «Artery First» Approach for Resection of Pancreatic Head Cancer // Journal of the American College of Surgeons. Elsevier Inc. 2010;210(2):e1.
Pessaux P, Varma D, Arnaud JP. Pancreaticoduodenectomy: Superior Mesenteric Artery First Approach // Journal of Gastrointestinal Surgery. Elsevier Inc. 2006;10(4):607–611.
Sanjay P, Takaori K, Govil S et al. «Artery-first» approaches to pancreatoduodenectomy // British Journal of Surgery. 2012;99(8):1027–1035.
Ironside N, Barreto SG, Loveday B et al. Meta-analysis of an artery-first approach versus standard pancreatoduodenectomy on perioperative outcomes and survival // British Journal of Surgery. John Wiley and Sons Ltd. 2018;105(6):628–636.
Negoi I, Hostiuc S, Runcanu A et al. Superior mesenteric artery first approach versus standard pancreaticoduodenectomy: a systematic review and meta-analysis // Hepatobiliary and Pancreatic Diseases International. Elsevier (Singapore) Pte Ltd. 2017;16(2):127–138.
Manabe T, Ohshio G, Baba N et al. Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas // Cancer. 1989;64(5):1132–1137.
Iqbal N, Lovegrove RE, Tilney HS et al. A comparison of pancreaticoduodenectomy with extended pancreaticoduodenectomy: A meta-analysis of 1909 patients // European Journal of Surgical Oncology. 2009;35(1):79–86.
Michalsk CW, Kleeff J, Wente MN et al. Systematic review and meta-analysis of standard and extended lymphadenectomy in pancreaticoduodenectomy for pancreatic cancer // British Journal of Surgery. 2007;94(3):265–273.
Orci LA, Meyer J, Combescure C et al. A meta-analysis of extended versus standard lymphadenectomy in patients undergoing pancreatoduodenectomy for pancreatic adenocarcinoma // HPB. Blackwell Publishing Ltd. 2015;17(7):565–572.
Tol JA, Gouma DJ, Bassi C et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: A consensus statement by the International Study Group on Pancreatic Surgery (ISGPS) // Surgery (United States). Mosby Inc. 2014;156(3):591–600.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
© АННМО «Вопросы онкологии», Copyright (c) 2022