Pancreatic Cancer Treatment and Research Center launched by Taipei Veterans General Hospital
Taipei Veterans General Hospital (VGH) was the first medical center to have the heavy iron radiotherapy or carbon iron radiotherapy (CIRT) in Taiwan. CIRT wound significant boost to the treatment of pancreatic cancer. In order to enhance the quality and effectiveness of pancreatic cancer treatment, the ' Therapeutic and Research Center of Pancreatic Cancer' (TRCPC) has been launched, bringing together the experienced experts from various departments. This center aims to become a formidable killer to the pancreas cancer, so-called 'King of Cancers', and hope to rewrite the history of pancreatic cancer treatment.
Surgical resection remains the most effective option for curing the pancreatic cancer so far. However, due to the inconspicuous symptoms in the early stages of pancreatic cancer, it is often diagnosed late and at an advanced stage where surgery is no longer feasible. In such cases, only palliative treatments involving chemotherapy and radiation are possible, earning it the nickname 'King of Cancers.' In contrast to traditional photon radiation therapy that passes through the body, heavy particles (carbon ions) can precisely target the tumor with minimal harm to the normal body tissue. For patients with locally advanced pancreatic cancer that cannot be curatively resected with surgery, a combination of chemotherapy and heavy iron radiotherapy or carbon iron radiotherapy (CIRT) can shrink the tumor, allowing for complete and curative resection and could provide a renewed chance at life for the pancreatic cancer patients.
Mr. Lee, a 74 years old male patient, presented in February 2023 with upper abdominal discomfort and weight loss. Examination revealed a pancreatic head cancer with encasement of the superior mesenteric vein and artery, making it inoperable due to the locally-advanced pancreatic cancer. After a combination of chemotherapy and heavy iron radiotherapy or carbon iron radiotherapy (CIRT), the tumor shrank from 4 centimeters to nearly imperceptible. In June, he successfully underwent a curative pancreaticoduodenectomy (surgery to remove the head of the pancreas and the duodenum). The surgical specimen showed minimal evidence of the tumor, and pathology examination only found single cells or rare small groups of cancer cells, indicating near complete response to neoadjuvant therapy, Modified Ryan Scheme score 1.
Director Yi-Ming Shyr emphasized that the missions of 'Pancreatic Cancer Treatment and Research Center' not only perform complex pancreatic surgeries but also integrate imaging, endoscopic ultrasound, and pathological diagnosis teams to swiftly, effectively and accurately diagnose patients, enabling early treatment and managing postoperative complications, resulting in a surgical mortality rate of less than 2%. For patients who cannot undergo surgical resection, the center can provide systemic chemotherapy or a combination of heavy iron radiotherapy or carbon iron radiotherapy (CIRT) to enhance local treatment control of pancreatic cancers. This approach could provide some previously inoperable patients the opportunity for surgery significantly improving the survival rate of pancreatic cancer and dispelling the reputation of being the 'King of Cancers" for the notorious pancreatic cancer.
戰勝癌王 北榮成立「胰臟癌治療及研究中心」
臺北榮總率先引進重粒子治癌技術,對於胰臟癌的治療如虎添翼!為提升胰臟癌治療品質及效能,再成立「胰臟癌治療暨研究中心」,整合各科優秀團隊,將成為「癌王」的剋星,改寫胰臟癌治療新歷史。
中心主任石宜銘教授表示,胰臟癌男性發生率為每十萬人口4.64位, 女性為每十萬人口3.21位,為我國癌症發生排名第13位,十大癌症死亡第7名。胰臟癌的原因至今仍不明確,但有些危險因子如有特定遺傳基因突變者及有遺傳慢性胰臟炎的人,發生胰臟癌的機率比平常人高。手術切除仍是目前胰臟癌治癒最有效的選項,然而胰臟癌早期因症狀不明顯不易察覺,往往一發現往往就是末期,因此無法手術,僅能以化學及放射姑息性治療,故有「癌王」之稱。蘋果創辦人賈伯斯、法國時裝界大師卡爾老佛爺、國際知名聲樂家帕華洛帝、知名體育主播傅達仁及資深藝人巴戈等都是因為胰臟癌過世。相較於傳統光子照射治療會貫穿人體,重粒子(碳離子)可精準照射腫瘤,對人體傷害小,針對胰臟癌局部晚期無法手術的患者,以化療合併重粒子治療後讓腫瘤縮小,可將腫瘤完全切除乾淨,讓胰臟癌患者出現一現生機,帶來重生的希望。
74歲的李先生,今(112)年二月因上腹部不適合併體重減輕就醫,檢查發現罹患胰臟頭癌合併上腸繫靜脈及動脈侵犯,為局部晚期手術無法切除乾淨,經化療合併重粒子治療後,腫瘤由4公分縮小到幾乎看不見,六月順利進行胰十二指腸切除手術,手術切除標本外觀幾乎看不到腫瘤,病理檢查也僅發現些許癌細胞,胰臟癌腫瘤標記 CA19-9由最高的219降至12.4(正常為小於27),目前復原良好,後續將繼續考慮化學治療加強效果。石宜銘主任強調,在引進重粒子治癌技術前,此類患者因為重要血管侵犯根本無法接受手術治癒,在臺北榮總醫療團隊的合作努力下,完成不可能的任務,也創造了醫學上的奇蹟。
胰臟癌的早期診斷較為困難,加上胰臟鄰近大血管與其他重要器官,因此增加手術切除的困難度,是一種預後相對較差的癌症。現今胰臟癌的治療,因新興的癌症治療武器於近幾年浮現,除手術、化學藥物與標靶藥物治療為胰臟癌病人的治療主流外,現今的精準治療、新藥臨床試驗正蓬勃發展中,希望能提升胰臟癌的治療成效。
臺北榮總「胰臟癌治療暨研究中心」,除擁有能執行各種困難胰臟手術優秀外科團隊,結合影像及內視鏡超音波與病理診斷團隊,可迅速精準診斷,讓病人及早接受治療,處理各種術後合併症,讓手術死亡率低於2%,傲視全球;另有經驗豐富的專責化學治療團隊,針對可手術切除的病人提供前導性/輔助性化學治療,加強手術前後的治療效果;而對於無法手術切除的病人提供全身性的化療,或合併光子治療與重粒子治療,加強胰臟腫瘤局部的控制與治療,讓部分原本無法手術的病人在治療後,仍有手術的機會,大大提高胰臟癌的存活率,讓民眾不再聞「癌王」色變。
有鑒於胰臟癌為診斷與治療困難度的惡性腫瘤,臺北榮總於2013年成立胰臟癌多專科醫療團隊,整合一般外科、胃腸肝膽科、內視鏡診斷暨治療中心、腫瘤內科、放射腫瘤科、新陳代謝科、放射線部、核子醫學部及病理檢驗部等,提供精確診斷、先進手術技術與全方位治療計畫,依據最新醫學證據建立胰臟癌病患標準治療指引並每年更新修訂,並藉由團隊會議給予病人最正確的診斷及最適當的治療建議,以期增進胰臟癌病人生活品質及存活時間。
胰臟手術是困難度極高的大手術,其中以胰十二指腸切除手術,也稱Whipple手術,最具挑戰性。傳統手術都需要很大的傷口,病人術後傷口疼痛指數破表,恢復非常辛苦。近年來微創技術以小傷口進行大手術,讓病人不再受罪。達文西機器手臂胰十二指腸切除微創手術更是高度困難的手術,並非每個醫院或醫師都有能力及條件發展,必需仰賴優秀且專精的胰臟團隊才可締造優異的成績進度得到病人的信賴。臺北榮總一般外科在石宜銘教授及微創中心主任王心儀教授率領的胰臟團隊努力下,積極發展「高度複雜且困難的達文西機器手臂胰十二指腸切除微創手術」。
臺北榮總胰臟團隊目前已有超過1900多例胰十二指腸切除手術的豐富經驗,在不斷努力下,完成超過590例達文西機器手臂胰十二指腸切除微創手術,寫下近乎苛求的紀錄(如下說明),病人對於整體手術滿意度高達99%,發表相關學術論文超過100篇,包括國際胰臟教科書章節1篇及達文西機器手臂胰微創手術論文發表48篇,為我國首屈一指的達文西胰臟微創手術團隊。
1.術後6日出院:相較於傳統大傷口的傳統手術平均住院天數約需31到36天,提早了快一個月。
2.微創傷口:傷口小到3~4公分,約傳統手術30~40公分的1/10。
3.出血量少:手術出血量少到幾乎“零”,平均出血量約100 c.c.,比起傳統手術約500 c.c.少很多。
4.機器手臂操作手術時間短:機器手臂操作手術時間可以快到小於4小時,只需232分鐘,比傳統手術6~8小時還快。
5.適合高齡及高危險病人:可以讓95歲病人順利出院,由於是微創手術,因此更適合高齡及高危險病人。
6.手術死亡率低,小於2%。
由於臺北榮總胰臟團隊傑出表現,王心儀主任於2018年9月受邀於瑞士日內瓦國際肝膽胰外科醫學會演講,並於2019年3月以臺灣唯一代表於美國邁阿密参與制定「國際」胰臟微創手術「規約」,在世界舞台發光發亮、為國爭光!臺北榮總胰臟團隊胰臟微創手術的量與質不只是臺灣第一,甚至在亞洲及世界已具有舉足輕重的地位。臺北榮總也以【胰臟移植 - 領先臺灣,傲視亞洲,超越歐美,世界之冠】及【微創機器手臂輔助胰臟手術 - ”胰”大手術小傷口】二項主題,分別於2017年及2019年榮獲號稱臺灣醫界奧斯卡獎的”國家品質標章SNQ(Symbol of National Quality)”品質銅獎,也是臺灣唯一擁有2項此殊榮的優秀胰臟團隊。