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EVALUATION OF RESECTABILITY FOR PANCREATIC HEAD CARCINOMA WITH DUAL-PHASE THINSLICE SPIRAL CT

目的 探討螺旋CT雙期薄層增強掃描對胰頭癌可切除性的評估價值。方法 回顧性分析24例經螺旋CT雙期薄層增強掃描胰頭癌的CT表現，觀察腫塊對鄰近器官或組織侵犯情況，以及有無遠處器官和淋巴結轉移，據此判斷腫塊能否切除，并將其結果與手術病理結果相對照。結果 螺旋CT判斷胰頭癌可切除的敏感性為90.9%，特異性為84.6%，陽性預測值為83.3%，陰性預測值為91.7%，準確性為87.5%。結論 螺旋CT雙期薄層增強掃描判斷胰頭癌可切除性的價值較高，對外科醫生選擇最佳治療方案有較大的幫助。

Pancreatic Carcinoma: Diagnosis and Preoperative Resectability Assessment by Using Gd-DTPA 3D FSPGR Dynamic MR Imaging

ObjectiveTo study the value of Gd-DTPA three dimension fast spoiled gradientecho (3D FSPGR) dynamic MRI in the diagnosis and preoperative respectability assessment of pancreatic carcinoma.MethodsThirty-two cases of pancreatic carcinoma verified by surgery and pathology were included in this study. All of the cases had MRI examinations two weeks before surgery. MRI protocols involved gradient echo T1 weighted（GRE T1W） with fat suppression, fast spin echo respiratory gating T2 weighted (FSE RG T2W) with fat suppression, MR cholangiopancreatography (MRCP) and gadolinium chelate 3D FSPGR T1W dynamic enhancement. Two radiologists reviewed MRI of the 32 cases retrospectively. Preoperative resectability of pancreatic carcinoma was assessed according to the characteristics of tumor lesions, peripancreatic invasion, vascular invasion, lymph node metastases, and liver metastases. The diagnosis and preoperative resectability assessment of pancreatic carcinoma by MRI was compared with surgical findings. ResultsOf 32 cases, 29 cases diagnosed by MRI were confirmed by surgery and pathology (accuracy of MRI, 90.6%). The sensitivity was 84.4%(27/32) and 93.8%(30/32) respectively for GRE T1W with fat-suppression combining FSE RG T2W and for Gd-DTPA 3D FSPGR dynamic MRI in the detection of pancreatic tumors. The accuracy was 87.5%（21/24）, 87.0%（20/23）, 80.0%（12/15）, 88.9%（8/9） and 83.3%（5/6） respectively for Gd-DTPA 3D FSPGR dynamic MRI in assessing local extension, vascular invasion, lymph node metastases, liver metastases and peritoneal carcinomatosis of pancreatic carcinoma. Eight cases of pancreatic carcinoma were considered to be resectable by enhanced MRI, while the tumors in 7 cases of the 8 cases were resected by surgery. Twentythree cases were confirmed nonresectable by surgery in the 24 cases of pancreatic carcinoma considered to be non-resectable by enhanced MRI. The sensitivity, specificity and accuracy were 87.5%，95.8% and 93.8% resectability for the assessment of respectability of pancreatic carcinoma by using Gd-DTPA 3D FSPGR dynamic MRI. There was no significant difference in the assessment of the resectability of pancreatic carcinoma between enhanced MRI and surgery or pathology （κ=0.83）.ConclusionUsing of Gd-DTPA 3D FSPGR dynamic enhanced MRI improves the detections of pancreatic carcinoma and metastasis. It is also accurate in the assessment of the resectability of pancreatic carcinoma.

Assessment of Laparoscopic Resectablity of Carcinoma of Gallbladder

The Preoperative Resectability Assessment of Hilar Cholangiocarcinoma

臨界可切除胰腺癌的腫瘤標志物檢測

目的研究臨界可切除胰腺癌的腫瘤標志物的臨床特點。 方法回顧性分析我院2012年1月至2015年12月期間收治的52例胰腺癌患者中的20例臨界可切除胰腺癌患者術前CA19-9、CA125及CEA水平，并與不可切除胰腺癌（23例）、可切除胰腺癌（9例）患者術前的腫瘤標志物水平進行比較。 結果臨界可切除胰腺癌患者血清中的CA19-9（U/mL）、CA125（U/mL）及CEA（μg/L）水平均明顯低于不可切除胰腺癌患者（278.5±23.9比546.2±34.8，P＜0.05；125.3±19.6比217.8±24.9，P＜0.05；11.6±2.5比19.4±3.9，P＜0.05），但明顯高于可切除胰腺癌患者（278.5±23.9比131.4±25.6，P＜0.05；125.3±19.6比97.8±19.9，P＜0.05；11.6±2.5比7.1±3.0，P＜0.05）。臨界可切除胰腺癌患者的術后生存時間（月）明顯長于不可切除胰腺癌患者（26.9±4.8比11.5±7.2，P＜0.05），與可切除胰腺癌患者比較差異無統計學意義（26.9±4.8比28.5±3.2，P＞0.05）。臨界可切除胰腺癌患者術后發生并發癥5例，其中輕、重度胰漏4例，消化道大出血1例，所有并發癥通過引流、抑制胰酶分泌、輸血、營養支持等保守治療治愈，無手術導致的死亡。可切除胰腺癌患者術后發生并發癥3例，其中膽汁漏1例，胰漏1例，腸梗阻1例，均保守治療治愈。 結論臨界可切除胰腺癌患者術前血清CA19-9、CA125及CEA水平與不可切除胰腺癌患者和可切除胰腺癌患者有一定的差異，具有與影像學特點相對應的臨床特點，結合術前MDCT結果可輔助判別胰腺腫瘤手術切除可能，減少不必要的剖腹探查。

Interpretation of the Society of Thoracic Surgeons expert consensus on the multidisciplinary management and resectability of locally advanced non-small cell lung cancer

With the continuous advancements in immunotherapy and targeted therapy, the treatment management and surgical resection assessment of locally advanced lung cancer have undergone significant changes. In October 2024, the Society of Thoracic Surgeons (STS) released the "STS expert consensus on the multidisciplinary management and resectability of locally advanced non-small cell lung cancer", which provides the latest insights on the evaluation of resectability and multidisciplinary management of locally advanced lung cancer, neoadjuvant (including perioperative) therapy, and adjuvant therapy. This article aims to interpret this consensus, with the goal of introducing the latest perspectives of the STS consensus to thoracic surgeons and providing a reference for the rational implementation of surgical resection, multidisciplinary management, and standardized comprehensive treatment models for non-small cell lung cancer in China.