关键词: 胰腺导管腺癌, 精准治疗, 新辅助治疗, 循环肿瘤DNA, 精准外科

Abstract: Pancreatic ductal adenocarcinoma (PDAC) is highly malignant with a poor prognosis, and the traditional "resectability" assessment based on radiological vascular invasion no longer meets clinical needs.With advances in perioperative treatment concepts, multidisciplinary collaboration, and technologies such as liquid biopsy, metabolic imaging, and molecular detection, the management of PDAC is shifting from an "anatomical resectability" model to a precision model oriented to "biological benefit".Preoperatively, risk stratification can be achieved through dynamic CA19-9 changes, staging laparoscopy, positron emission tomography (PET/CT), and circulating tumor DNA (ctDNA), supplemented by radiomics and artificial intelligence, to better identify patients who will benefit from surgery.Neoadjuvant therapy improves the R0 resection rate while also providing biological selection and optimizing surgical timing.Surgically, the focus is on rationally optimizing the extent of resection while ensuring R0 resection, involving vascular resection and reconstruction, lymph node dissection, and nerve plexus management.Postoperatively, stratification of adjuvant therapy and ctDNA-based monitoring of minimal residual disease offer new approaches to recurrence risk identification and dynamic management.This review summarizes the key surgical issues in the precision treatment of PDAC to provide a reference for clinical decision-making.

Key words: pancreatic ductal adenocarcinoma, precision treatment, neoadjuvant therapy, circulating tumor DNA, precision surgery