系统治疗背景下对胰腺癌手术指征再认识OA

Locally advanced pancreatic cancer(LAPC)has long been classified as unresectable pancreatic cancer owing to invasion of adjacent vital blood vessels.In recent years,with advances in surgical techniques and the widespread adoption of updated systemic treatment,a subset of patients with LAPC can achieve access to radical surgery after conversion therapy.Accordingly,the evaluation of surgical indications is transitioning from the traditional imaging-based anatomical assessment to a comprehensive evaluation integrating biological behavior and anatomical alterations.Assessment of tumor-vessel relationship remains the core determinant of resectability throughout the preoperative and intraoperative periods.The application of surgical techniques including combined autologous small bowel transplantation and sub-adventitial divestment technique has also facilitated the development of curative resection,yet such procedures rely heavily on clinical experience from high-volume pancreatic centers.With the advancement of precision medicine and artificial intelligence,novel conversion regimens and evaluation systems will enable more precise identification of patients who can achieve long-term survival benefits from curative surgery,ultimately leading to sustained improvements in long-term survival.