文章：

胰腺癌手术中肿瘤的术中检测与分期：当前标准与未来方向的整合性综述

Intra-Operative Tumour Detection and Staging in Pancreatic Cancer Surgery: An Integrative Review of Current Standards and Future Directions

原文发布日期：12 November 2024

DOI: 10.3390/cancers16223803

类型: Article

开放获取: 是

英文摘要：

Background: Surgical resection for pancreatic ductal adenocarcinoma (PDAC) entails the excision of the primary tumour and regional lymphadenectomy. This traditional strategy is challenged by the high rate of early recurrence, suggesting inadequate disease staging. Novel methods of intra-operative staging are needed to allow surgical resection to be tailored to the disease’s biology. Methods: A search of published articles on the PubMed and Embase databases was performed using the terms ‘pancreas’ OR ‘pancreatic’ AND ‘intra-operative staging/detection’ OR ‘guided surgery’. Articles published between January 2000 and June 2023 were included. Technologies that offered intra-operative staging and tailored treatment were curated and summarised in the following integrative review. Results: lymph node (LN) mapping and radioimmunoguided surgery have shown promising results but lacked practicality to facilitate real-time intra-operative staging for PDAC. Fluorescence-guided surgery (FGS) offers high contrast and sensitivity, enabling the identification of cancerous tissue and positive LNs with improved precision following intravenous administration of a fluorescent agent. The unique properties of optical coherence tomography and ultrasound elastography lend themselves to be platforms for virtual biopsy intra-operatively. Conclusions: Accurate intra-operative staging of PDAC, localisation of metastatic LNs, and identification of extra-pancreatic disease remain clinically unmet needs under current detection methods and staging standards. Tumour-specific FGS combined with other diagnostic and therapeutic modalities could improve tumour detection and staging in patients with PDAC.

摘要翻译： 

背景：胰腺导管腺癌（PDAC）的手术切除包括原发肿瘤切除及区域淋巴结清扫。然而，传统手术策略面临早期复发率高的挑战，提示现有疾病分期方法存在不足。需要开发新型术中分期技术，以实现根据肿瘤生物学特性定制手术方案。方法：在PubMed和Embase数据库中，使用“胰腺”或“胰腺癌”与“术中分期/检测”或“引导手术”组合检索词，对2000年1月至2023年6月期间发表的文献进行检索。本文整合综述中系统梳理并总结了能够实现术中分期与个体化治疗的相关技术。结果：淋巴结示踪技术与放射免疫引导手术虽展现应用潜力，但尚缺乏实现PDAC实时术中分期的实用性。荧光引导手术通过静脉注射荧光造影剂，能以高对比度和灵敏度实现癌组织与阳性淋巴结的精准识别。光学相干断层扫描和超声弹性成像凭借其独特性能，可作为术中虚拟活检的技术平台。结论：在当前检测方法与分期标准下，实现PDAC精准术中分期、转移性淋巴结定位及胰腺外病变识别仍是临床未满足的需求。肿瘤特异性荧光引导手术联合其他诊断治疗模式，有望提升PDAC患者的肿瘤检测与分期水平。

原文链接：

Intra-Operative Tumour Detection and Staging in Pancreatic Cancer Surgery: An Integrative Review of Current Standards and Future Directions