Pancreatic ductal adenocarcinoma (PDAC) is an aggressive disease with high morbidity and mortality in which long-term survival rates remain disastrous. Surgical resection is the only potentially curable treatment for early pancreatic cancer; however, the right patient qualification is crucial for optimizing treatment outcomes. With the rapid development of radiographic and surgical techniques, resectability decisions are made by a multidisciplinary team. Upfront surgery (Up-S) can improve the survival of patients with potentially resectable disease with the support of adjuvant therapy (AT). However, early recurrences are quite common due to the often-undetectable micrometastases occurring before surgery. Adopted by international consensus in 2017, the standardization of the definitions of resectable PDAC (R-PDAC) and borderline resectable PDAC (BR-PDAC) disease was necessary to enable accurate interpretation of study results and define which patients could benefit from neoadjuvant therapy (NAT). NAT is expected to improve the resection rate with a negative margin to provide significant local control and eliminate micrometastases to prolong survival. Providing information about optimal sequential multimodal NAT seems to be key for future studies. This article presents a multidisciplinary concept for the therapeutic management of patients with R-PDAC and BR-PDAC based on current knowledge and our own experience.
胰腺导管腺癌（PDAC）是一种侵袭性疾病，发病率和死亡率均较高，其长期生存率仍处于极低水平。手术切除是早期胰腺癌唯一可能治愈的治疗手段；然而，正确的患者筛选对于优化治疗效果至关重要。随着影像学和外科技术的快速发展，可切除性评估需由多学科团队共同决策。在辅助治疗的支持下，直接手术可提高潜在可切除患者的生存率。但由于术前常存在难以检测的微转移灶，早期复发相当常见。2017年国际共识采纳了可切除PDAC和临界可切除PDAC的标准化定义，这对于准确解读研究结果、明确哪些患者能从新辅助治疗中获益至关重要。新辅助治疗有望提高阴性切缘切除率，实现显著的局部控制，并通过消除微转移灶延长生存期。探索最佳序贯多模式新辅助治疗方案将成为未来研究的关键。本文基于现有知识及自身经验，提出了针对可切除及临界可切除PDAC患者治疗管理的多学科诊疗理念。
肿瘤(癌症)患者之家