Pankreas Tümörlerinde Operabl, Borderline ve Medikal İnoperabl Kavramları
Özet
Pankreas kanseri, düşük sağkalım oranları nedeniyle kritik bir klinik yönetimi gerektiren, dünyadaki dördüncü önde gelen kanser ölüm nedenidir. Tedavide potansiyel kür sağlayan tek seçenek cerrahi R0 rezeksiyonu olduğundan, hastaların radyolojik görüntüleme (BT ve MRG) eşliğinde operabl, borderline (sınırda rezektabl) veya anrezektabl olarak sınıflandırılması hayati önem taşır. Operabl tümörler, vasküler temasın olmadığı ve doğrudan cerrahi ile adjuvan tedaviye uygun vakalardır; ancak güncel çalışmalar neoadjuvan tedavinin bu grupta da sağkalım avantajı sağlayabileceğini göstermektedir. Borderline tümörler, vasküler tutulumun derecesine göre R0 rezeksiyon şansı taşıyan ve genellikle neoadjuvan FOLFİRİNOX rejimi sonrası cerrahiye yönlendirilen grubu temsil ederken, uzak metastazı veya yaygın vasküler invazyonu olan hastalar anrezektabl olarak kabul edilerek palyatif tedavilere yönlendirilir. Bunlara ek olarak, net bir konsensus bulunmamakla birlikte, ileri yaş ve ek hastalıklar nedeniyle cerrahiyi tolere edemeyecek hastalar "medikal inoperabl" olarak tanımlanır. Sonuç olarak, multidisipliner bir yaklaşımla yapılan doğru evreleme, hem cerrahi şansını optimize etmek hem de uygun olmayan hastalarda gereksiz morbiditeyi önlemek açısından kritiktir.
Pancreatic cancer is the fourth leading cause of cancer-related deaths worldwide, requiring critical clinical management due to its poor survival rates. Since surgical R0 resection is the only option providing a potential cure, classifying patients as operable, borderline resectable, or unresectable through radiological imaging (CT and MRI) is of vital importance. Operable tumors are cases without vascular involvement suitable for direct surgery and adjuvant therapy; however, recent studies indicate that neoadjuvant therapy may also provide a survival advantage in this group. Borderline tumors represent the group that carries a chance for R0 resection based on the degree of vascular involvement and is typically directed to surgery following a neoadjuvant FOLFIRINOX regimen, while patients with distant metastasis or extensive vascular invasion are considered unresectable and referred for palliative treatments. Additionally, although no clear consensus exists, patients who cannot tolerate surgery due to advanced age or comorbidities are defined as "medically inoperable." In conclusion, accurate staging performed through a multidisciplinary approach is critical for both optimizing surgical opportunities and preventing unnecessary morbidity in unsuitable patients.
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