胰腺癌

• How do pylorus-preserving and classic pancreaticoduodenectomy compare in people undergoing surgical treatment of periampullary and pancreatic carcinoma?
  显示答案
• In people with pancreatic cancer, how does laparoscopic pancreatectomy compare with open distal pancreatectomy at improving outcomes?
  显示答案
• In people with locally advanced pancreatic cancer, is there randomized controlled trial evidence to support the use of resection instead of palliative treatment?
  显示答案
• How do gemcitabine‐containing dual chemotherapy regimens compare with gemcitabine alone for people with advanced pancreatic cancer?
  显示答案
• How does gemcitabine compare with non‐gemcitabine‐containing regimens for people with advanced pancreatic cancer?
  显示答案
• How does celiac plexus block affect compare with other analgesics in adults with pancreatic cancer pain?
  显示答案
• In patients undergoing pancreatic surgery, what are the benefits and harms of post-operative administration of somatostatin analogues?
  显示答案
• After pancreaticoduodenectomy, how does anastomosis between the pancreatic stump and the jejunum compare with anastomosis between the pancreatic stump and the stomach?
  显示答案
• What are the benefits and harms of fibrin sealants for preventing postoperative pancreatic fistula following pancreatic surgery?
  显示答案

证据评分

证据 A 不可切除性胰腺癌引起的梗阻性黄疸症状的缓解：高级别证据表明内镜下金属支架置入可解决胰腺癌引起的梗阻性黄疸。[69]Moss AC, Morris E, Mac Mathuna P. Palliative biliary stents for obstructing pancreatic carcinoma. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD004200.https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004200.pub4/fullhttp://www.ncbi.nlm.nih.gov/pubmed/16625598?tool=bestpractice.com 系统评价或者受试者＞200名的随机对照临床试验（RCT）。

不可切除性胰腺癌引起的梗阻性黄疸症状的缓解：高级别证据表明内镜下金属支架置入可解决胰腺癌引起的梗阻性黄疸。[69]Moss AC, Morris E, Mac Mathuna P. Palliative biliary stents for obstructing pancreatic carcinoma. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD004200.https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004200.pub4/fullhttp://www.ncbi.nlm.nih.gov/pubmed/16625598?tool=bestpractice.com

证据 A 生存率和临床获益于吉西他滨：高级别证据表明在姑息性治疗有症状的晚期胰腺癌方面，吉西他滨效果优于氟尿嘧啶， 研究同时表明接受吉西他滨治疗的患者比接受氟尿嘧啶治疗者的1年生存率高。[88]Burris HA 3rd, Moore MJ, Andersen J, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol. 1997 Jun;15(6):2403-13.http://www.ncbi.nlm.nih.gov/pubmed/9196156?tool=bestpractice.com 系统评价或者受试者＞200名的随机对照临床试验（RCT）。

生存率和临床获益于吉西他滨：高级别证据表明在姑息性治疗有症状的晚期胰腺癌方面，吉西他滨效果优于氟尿嘧啶， 研究同时表明接受吉西他滨治疗的患者比接受氟尿嘧啶治疗者的1年生存率高。[88]Burris HA 3rd, Moore MJ, Andersen J, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol. 1997 Jun;15(6):2403-13.http://www.ncbi.nlm.nih.gov/pubmed/9196156?tool=bestpractice.com

证据 B 吸烟人群中患胰腺癌的风险：有从1950到2007年报道的82项试验的中级别证据META分析表明，吸烟人群患胰腺癌的风险增加1.74倍（95%CI 1.61-1.87）。[14]Iodice S, Gandini S, Maisonneuve P, et al. Tobacco and the risk of pancreatic cancer: a review and meta-analysis. Langenbecks Arch Surg. 2008 Jul;393(4):535-45.http://www.ncbi.nlm.nih.gov/pubmed/18193270?tool=bestpractice.com 系统评价或者受试者＞200名的随机对照临床试验（RCT）。

吸烟人群中患胰腺癌的风险：有从1950到2007年报道的82项试验的中级别证据META分析表明，吸烟人群患胰腺癌的风险增加1.74倍（95%CI 1.61-1.87）。[14]Iodice S, Gandini S, Maisonneuve P, et al. Tobacco and the risk of pancreatic cancer: a review and meta-analysis. Langenbecks Arch Surg. 2008 Jul;393(4):535-45.http://www.ncbi.nlm.nih.gov/pubmed/18193270?tool=bestpractice.com

证据 B 超重或肥胖患者患胰腺癌的风险：中级别证据表明超重或肥胖是患胰腺癌的高危因素，独立于糖尿病和疾病初期。 老年期肥胖，在还未诊断患癌前，降低了总体生存率。[17]Aune D, Greenwood DC, Chan DS, et al. Body mass index, abdominal fatness and pancreatic cancer risk: a systematic review and non-linear dose-response meta-analysis of prospective studies. Ann Oncol. 2012 Apr;23(4):843-52.https://academic.oup.com/annonc/article/23/4/843/209065http://www.ncbi.nlm.nih.gov/pubmed/21890910?tool=bestpractice.com[18]Li D, Morris JS, Liu J, et al. Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. JAMA. 2009 Jun 24;301(24):2553-62.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760963/http://www.ncbi.nlm.nih.gov/pubmed/19549972?tool=bestpractice.com 系统评价或者受试者＞200名的随机对照临床试验（RCT）。

超重或肥胖患者患胰腺癌的风险：中级别证据表明超重或肥胖是患胰腺癌的高危因素，独立于糖尿病和疾病初期。 老年期肥胖，在还未诊断患癌前，降低了总体生存率。[17]Aune D, Greenwood DC, Chan DS, et al. Body mass index, abdominal fatness and pancreatic cancer risk: a systematic review and non-linear dose-response meta-analysis of prospective studies. Ann Oncol. 2012 Apr;23(4):843-52.https://academic.oup.com/annonc/article/23/4/843/209065http://www.ncbi.nlm.nih.gov/pubmed/21890910?tool=bestpractice.com[18]Li D, Morris JS, Liu J, et al. Body mass index and risk, age of onset, and survival in patients with pancreatic cancer. JAMA. 2009 Jun 24;301(24):2553-62.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760963/http://www.ncbi.nlm.nih.gov/pubmed/19549972?tool=bestpractice.com

证据 B 腺癌切缘阳性患者的生存率：中级别证据表明化疗是一项有效的辅助治疗，效果优于同步放化疗， 有试验表明胰腺癌切缘阳性的患者接受化疗后，2年和5年生存率要比未接受化疗者高。[62]Stocken DD, Büchler MW, Dervenis C, et al. Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer. Br J Cancer. 2005 Apr 25;92(8):1372-81.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361989/http://www.ncbi.nlm.nih.gov/pubmed/15812554?tool=bestpractice.com 系统评价或者受试者＞200名的随机对照临床试验（RCT）。

腺癌切缘阳性患者的生存率：中级别证据表明化疗是一项有效的辅助治疗，效果优于同步放化疗， 有试验表明胰腺癌切缘阳性的患者接受化疗后，2年和5年生存率要比未接受化疗者高。[62]Stocken DD, Büchler MW, Dervenis C, et al. Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer. Br J Cancer. 2005 Apr 25;92(8):1372-81.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361989/http://www.ncbi.nlm.nih.gov/pubmed/15812554?tool=bestpractice.com

证据 C 新发糖尿病患者患胰腺癌的风险：从一项2000多人的队列研究的低级别证据表明，在近3年内被诊断为新发糖尿病的患者患胰腺癌的概率有1%， 然而以新发糖尿病这一指标诊断早期胰腺癌的价值需进一步研究。[4]Chari ST, Leibson CL, Rabe KG, et al. Probability of pancreatic cancer following diabetes: a population-based study. Gastroenterology. 2005 Aug;129(2):504-11.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377196/http://www.ncbi.nlm.nih.gov/pubmed/16083707?tool=bestpractice.com 系统评价或者受试者＞200名的随机对照临床试验（RCT）。

新发糖尿病患者患胰腺癌的风险：从一项2000多人的队列研究的低级别证据表明，在近3年内被诊断为新发糖尿病的患者患胰腺癌的概率有1%， 然而以新发糖尿病这一指标诊断早期胰腺癌的价值需进一步研究。[4]Chari ST, Leibson CL, Rabe KG, et al. Probability of pancreatic cancer following diabetes: a population-based study. Gastroenterology. 2005 Aug;129(2):504-11.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377196/http://www.ncbi.nlm.nih.gov/pubmed/16083707?tool=bestpractice.com