Nüks Pankreas Kanserinde Cerrahinin Yeri
Özet
Pankreas duktal adenokarsinomu (PDAC), agresif doğası nedeniyle cerrahi rezeksiyon sonrasında bile hastaların yaklaşık %80'inde lokal nüks veya uzak metastaz ile seyreden yüksek riskli bir malignitedir. Nükslerin erken tespiti amacıyla hastalar postoperatif dönemde 3 ayda bir torakoabdominopelvik BT, CEA ve CA 19-9 takibine alınır; şüpheli durumlarda ise PET-BT ve konfirmasyon biyopsisi uygulanır. Takipte CA 19-9 seviyesinin normale dönmemesi veya yükselmesi, kötü prognoz ve erken nüksün güçlü bir göstergesidir. Nüks saptanan hastalarda, lezyon rezektabl ise ve uzak organ metastazı bulunmuyorsa, total pankreatektomiye tamamlama veya bakiye pankreasın korunması gibi cerrahi seçenekler ilk tedavi tercihini oluşturur. Cerrahi uygulanan bu hastalarda nüks sonrası medyan sağkalım süresi, rezeke edilemeyen gruba kıyasla belirgin şekilde daha yüksektir. Tedavi protokolüne 5-FU veya gemsitabin tabanlı adjuvan kemoterapi ile uygun vakalarda radyoterapinin eklenmesi sağkalımı optimize eder. Pankreas nöroendokrin tümörlerinde (NET) ise nüks oranları yüksek olsa da tekrarlayan cerrahi girişimlerle 10 yıllık sağkalım %70'lere ulaşabilmektedir. Sonuç olarak, izole nüks varlığında multidisipliner yaklaşımla cerrahi rezeksiyon ve adjuvan tedavilerin kombinasyonu hastaların sağkalım süresini uzatmada en etkili stratejidir.
Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy characterized by a high recurrence rate, with approximately 80% of patients developing local recurrence or distant metastasis even after curative surgical resection. To ensure early detection of recurrence, postoperatve surveillance is performed every three months using thoracoabdominopelvic CT along with CEA and CA 19-9 biomarker evaluations; PET-CT and confirmation biopsies are utilized in suspected cases. Postoperative elevation or failure of CA 19-9 levels to normalize serves as a strong indicator of poor prognosis and early recurrence. In cases of isolated recurrence, surgical resection remains the primary treatment option if the lesion is resectable and no distant organ metastasis is present, utilizing options like completion total pancreatectomy or preservation of the pancreatic remnant. Patients undergoing re-resection demonstrate significantly higher median survival times compared to the unresectable group. Integrating 5-FU or gemcitabine-based adjuvant chemotherapy and radiotherapy further optimizes survival outcomes. For pancreatic neuroendocrine tumors (NETs), despite frequent recurrences, aggressive repeat surgeries achieve an excellent 10-year survival rate of up to 70%. Consequently, a multidisciplinary approach combining surgical re-resection and adjuvant therapies constitutes the most effective strategy to prolong patient survival.
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