Pancreatic ductal adenocarcinoma (PDAC) remains associated with poor outcomes with a 5-year survival of 12% across all stages of the disease. These poor outcomes are driven by a delay in diagnosis and an early propensity for systemic dissemination of the disease. Recently, aggressive surgical approaches involving complex vascular resections and reconstructions have become more common, thus allowing more locally advanced tumors to be resected. Unfortunately, however, even after the completion of surgery and systemic therapy, approximately 40% of patients experience early recurrence of disease. To determine resectability, many institutions utilize anatomical staging systems based on the presence and extent of vascular involvement of major abdominal vessels around the pancreas. However, these classification systems are based on anatomical considerations only and do not factor in the burden of systemic disease. By integrating the biological criteria, we possibly could avoid futile resections often associated with significant morbidity. Especially patients with anatomically resectable disease who have a heavy burden of radiologically undetected systemic disease most likely do not derive a survival benefit from resection. On the contrary, we could offer complex resections to those who have locally advanced or oligometastatic disease but have favorable systemic biology and are most likely to benefit from resection. This review summarizes the current literature on defining anatomical and biological resectability in patients with pancreatic cancer.
胰腺导管腺癌（PDAC）的预后仍然较差，所有分期患者的5年生存率仅为12%。这种不良预后主要源于诊断延迟以及疾病早期即出现全身性扩散的倾向。近年来，涉及复杂血管切除与重建的积极手术方式日益普及，使得更多局部进展期肿瘤得以切除。然而遗憾的是，即使完成手术及全身系统治疗，仍有约40%患者出现早期复发。为评估可切除性，多数医疗机构采用基于胰腺周围主要腹部血管受累情况及范围的解剖学分期系统。但这些分类体系仅基于解剖学考量，未纳入全身性疾病负荷因素。通过整合生物学标准，我们或许能避免常伴随显著并发症的无效切除。特别是那些解剖学上可切除但存在大量影像学未检出的全身性疾病负荷的患者，很可能无法从切除术中获得生存获益。相反，对于局部进展期或寡转移但具有良好全身生物学特征、最可能从切除术中获益的患者，我们可以提供复杂切除方案。本综述总结了当前关于胰腺癌患者解剖学与生物学可切除性定义的文献。
Anatomical and Biological Considerations to Determine Resectability in Pancreatic Cancer
肿瘤(癌症)患者之家