When the patient has no metastases and the tumor is not considered as borderline resectable, the tumor is defined as truly locally advanced. Treatment of this group of patients remains highly controversial. Regardless of the treatment strategy, the average OS for these patients remains low (<1 year) in the oldest studies. Recently in some trial patients with locally advanced disease, treated with chemotherapy alone achieved 16 months overall median survival. Researchers are studying cryosurgery as a possible treatment for pancreatic cancer. The aim of the study was to improve the results of treatment in patients with locally advanced pancreatic cancer using open cryoablation in combination with chemotherapy. Since January 2012, оpen cryoablation has been performed in 62 pts with locally advanced pancreatic cancer (male-28(45.2%), female–34(54.8%). The mean age was 56.4±6.4 years. The size of the tumors ranged from 4,0 to 10,0 cm. Cryoablation in combination with bilioenteric bypass was performed in 18(29 %) cases, with retrograde endoscopic stenting in 22 (35.5%) cases. The Russian cryosurgical devices "KRIO-MT" and "KRIO-01" were used, as well as porous-sponge applicators made of titanium nickeline. Cryo-applicators had diameter from 2 to 5 cm. The target temperature was -186 ºС. Exposure time - from 3 to 5 min. The number of sessions depended on the size of the tumor and ranged from 1 to 5 (2.4 on average). All patients subsequently underwent adjuvant chemotherapy, in 10 cases, supplemented with regional chemoembolization. Intraabdominal bleeding developed in 2(3.2%) patients, acute pancreatitis - in 8(12.9%) cases, wound infection - in 2 (3.2%), eventration - in 1 (1.6%). Ascites was detected in 12 (19.5%). There was no postoperative mortality. Down staging of the tumor was achieved in 4(6.5%) patients and they were successfully operated. Complete disappearance of the pain was observed in 42.2% of patients, and its significant decrease in 41.6%. Long term Kaplan-Meier survival in patients with locally advanced pancreatic cancer treated by open cryoablation in combination with adjuvant chemotherapy was: 6 months – 92%, 12 months – 84%, 24 months – 48%, 36 months – 14% (Median – 18.2 months). Cryoablation in patients with locally advanced pancreatic cancer improves the quality of life due to pain relief. Cryoablation in combination with chemotherapy increases survival rate. Сryoablation may be promising in multidisciplinary approach in the treatment of locally advanced pancreatic cancer.

Alexey V. Chzhao教授丨第二十一届世界冷冻大会发言：题目《局部晚期胰腺癌的冷冻消融术》

当病人没有转移，且肿瘤不被认为是可切除的边缘，则被定义为真正的局部晚期。对这组病人的治疗仍有很大争议。无论采用何种治疗策略，在最古老的研究中，这些患者的平均OS仍然很低（<1年）。最近，在一些试验中，局部晚期疾病患者仅通过化疗就获得了16个月的总中位生存期。研究人员正在研究冷冻手术作为胰腺癌的一种可能的治疗方法。研究的目的是提高局部晚期胰腺癌患者的治疗效果，使用开放式低温消融术与化疗相结合。自2012年1月以来，已对62名局部晚期胰腺癌患者进行了开放式冷冻消融术（男性28人（45.2%），女性34人（54.8%））。平均年龄为56.4±6.4岁。肿瘤的大小从4.0到10.0厘米不等。在18（29%）个病例中进行了冷冻消融结合胆肠分流术，在22（35.5%）个病例中进行了逆行内镜支架术。使用了俄罗斯的冷冻手术设备 "KRIO-MT "和 "KRIO-01"，以及由钛镍线制成的多孔海绵涂抹器。冷冻施放器的直径为2至5厘米。目标温度为-186 ºС。暴露时间 - 从3到5分钟。治疗次数取决于肿瘤的大小，从1到5次不等（平均2.4次）。所有患者随后都接受了辅助化疗，其中10例还辅以区域化疗栓塞治疗。2名（3.2%）患者出现腹腔出血，8名（12.9%）患者出现急性胰腺炎，2名（3.2%）患者出现伤口感染，1名（1.6%）患者出现浸润。12例（19.5%）患者发现有腹水。无术后死亡病例。4名（6.5%）患者实现了肿瘤的向下分期，并成功进行了手术。42.2%的患者疼痛完全消失，41.6%的患者疼痛明显减轻。局部晚期胰腺癌患者通过开放式低温消融术结合辅助化疗治疗的长期Kaplan-Meier生存率为：6个月-92%，12个月-84%，24个月-48%，36个月-14%（中位数-18.2个月）。局部晚期胰腺癌患者的冷冻消融术因疼痛缓解而提高了生活质量。冷冻消融术与化疗联合使用可提高生存率。在治疗局部晚期胰腺癌的多学科方法中，冷冻消融术可能是有前途的。