外科紅黑版畫系列

中文譯文　摘要　胰腺癌是一種少見但致命的疾病。由於腫瘤尚侷限時缺乏症狀或症狀不典型，患者確診時多已屬進展期。高質量影像處理系統已實際用於胰腺腫瘤的檢出與手術可行性的判斷，ERCP 等術前手段也日益增多地用於補充分期。胰十二指腸切除術是具有潛在併發症風險的複雜手術之一；過去十年間，機器人輔助與腹腔鏡微創胰腺切除已在世界範圍內成爲標準外科實踐的一部分。此外，輔助化療的進展改善了當前臨牀實踐中的長期結局；包括靶向藥物在內的系統性保守治療仍是晚期患者的主要治療手段。越來越多的研究着眼於調控胰腺腫瘤微環境，以提高免疫治療策略的療效。本文考察了術前治療、新手術策略與個體化全身治療在胰腺癌中的作用，並總結了確立胰腺癌新輔助與外科治療方案的隨機對照研究。關鍵詞：里程碑；胰腺癌

Abstract Pancreatic cancer is a rare but fatal disease. Patients present advanced disease due to the lack of or typical symptoms when the tumor is still localized. A high-quality image processing system has been in practice to detect the pancreatic tumor and determine the possibility of surgery, and preoperative methods, such as ERCP are increasingly used to complement the staging modality. Pancreaticoduodenectomy is one of the complicated surgeries with potential morbidity. The minimally invasive pancreatic resections, both robot-assisted and laparoscopic, have become a part of standard surgical practice worldwide over the last decade. Moreover, advancements in adjuvant chemotherapy have improved the long-term outcomes in current clinical practice. The systemic conservative treatment, including targeted agents, remains the mainstay of treatment for patients with advanced disease. An increasing number of studies are focused on modulating the pancreatic tumor microenvironment to improve the efficacy of the immunotherapeutic strategies. Herein, the role of preoperative therapy, the novel surgical strategy, and individualized systemic treatment in pancreatic cancer is investigated. Also, the randomized controlled studies that have defined the neoadjuvant and surgical management of pancreatic cancer have been summarized. Keywords: Landmarks, Pancreatic cancer