精准解剖理念在胰腺癌根治术中实践与争议OA

The quality of resection in radical surgery for pancreatic cancer directly affects patient prognosis.For a long time,extending the extent of resection was regarded as the main approach to achieving radical cure;however,its survival benefit has never been supported by high-quality evidence.In recent years,the concept of precise anatomy has gradually emerged in pancreatic surgery,emphasizing well-defined anatomical planes as the operative path and unified grading criteria for defining resection,making radical surgery a standardized procedure that can be described,assessed,and passed on.In the present era of continuous breakthroughs in systemic therapy,surgical precision has not been weakened;on the contrary,it has become increasingly important.The better the systemic control,the greater the impact of local resection quality on patient outcomes.Current evidence indicates that techniques,including total mesopancreas excision,the Heidelberg triangle operation,the arterial divestment technique,and radical antegrade modular pancreatosplenectomy(RAMPS),improve surrogate endpoints such as the R0 resection rate and local recurrence,whereas their benefit for overall survival remains unconfirmed.The value of the precise anatomy concept lies in establishing operative paradigms and anatomical standards,rather than in unlimited expansion of the resection extent.Exercising restraint where evidence is lacking and pursuing standardization where standards exist represent the true significance of the precise anatomy concept in radical surgery for pancreatic cancer.