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Chirurgie maligner Pankreastumoren

Surgery of malignant pancreatic tumors

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Zusammenfassung

Das duktale Adenokarzinom ist der häufigste maligne Pankreastumor. Trotz intensiver Anstrengungen auf dem Gebiet der Pankreasforschung konnte die Gesamtprognose in den vergangenen Jahren nicht entscheidend verbessert werden. Die einzige potenziell kurative Therapie ist die chirurgische Resektion. In Kombination mit einer adjuvanten Chemotherapie liegen die 5-Jahres-Überlebensraten aktuell bei 20–25%. Dank kontinuierlicher Weiterentwicklung der chirurgischen Operationstechnik und Verbesserungen der perioperativen Versorgung der Patienten mit einer engen interdisziplinären Zusammenarbeit (Chirurgie, Anästhesie, Onkologie, Radiologie und Pflege) konnten die perioperative Morbiditäts- und Mortalitätsraten in den vergangenen Jahren deutlich gesenkt werden. Unter den erweiterten Resektionsverfahren sind Venen- oder multiviszerale Resektionen technisch sicher durchführbar und sinnvoll, wenn eine makroskopische Tumorfreiheit erreicht werden kann. Multimodale Therapiekonzepte bieten viel versprechende Ansätze, wobei derzeit jedoch nur die adjuvante Chemotherapie aufgrund randomisierter kontrollierter Studien zur Standardtherapie nach chirurgischer Resektion gehört.

Abstract

Ductal adenocarcinoma is the most common malignant tumor of the pancreas. Despite great efforts in basic and clinical pancreatic cancer research, the prognosis remains poor with an overall 5-year survival rate of less than 5%. Complete surgical resection represents the only curative treatment option and 5-year survival rates of 20–25% can be achieved following curative resection and adjuvant chemotherapy. Although pancreatic surgery is considered one of the most technically demanding and challenging procedures, there has been constant progress in surgical techniques and advances in perioperative care with a modern interdisciplinary approach including anesthesiology, oncology, radiology and nursing. This has reduced morbidity and especially mortality rates in high-volume centers. Among extended resection procedures multivisceral and venous resections are technically feasible and should be considered if a complete tumor resection can be achieved. Multimodal regimens have shown promising results, however, only adjuvant chemotherapy is supported by solid evidence from randomized controlled trials.

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Notes

  1. Empfehlungsgrad A basiert auf systematischen Übersichtsarbeiten über randomisierte kontrollierte Studien (RCT) oder einzelnen gut durchgeführten RCT; Empfehlungsgrad B basiert auf systematischen Übersichtsarbeiten gut durchgeführter Kohortenstudien (KS), einzelnen gut durchgeführten KS oder RCT minderer Qualität; Empfehlungsgrad C basiert auf Fall-Kontroll-Studien, Fallserien oder KS minderer Qualität; Empfehlungsgrad D basiert auf Expertenmeinungen oder mangelhaften, nicht schlüssigen Studien jeder Evidenzgrade.

Literatur

  1. Jemal A, Siegel R, Ward E et al (2008) Cancer statistics. CA Cancer J Clin 58(2):71–96

    Article  PubMed  Google Scholar 

  2. Wagner M, Redaelli C, Lietz M et al (2004) Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg 91(5):586–594

    Article  PubMed  CAS  Google Scholar 

  3. Cameron JL, Riall TS, Coleman J, Belcher KA (2006) One thousand consecutive pancreaticoduodenectomies. Ann Surg 244(1):10–15

    Article  PubMed  Google Scholar 

  4. Sener SF, Fremgen A, Menck HR, Winchester DP (1999) Pancreatic cancer: a report of treatment and survival trends for 100,313 patients diagnosed from 1985-1995, using the National Cancer Database. J Am Coll Surg 189(1):1–7

    Article  PubMed  CAS  Google Scholar 

  5. Siriwardana HP, Siriwardena AK (2006) Systematic review of outcome of synchronous portal-superior mesenteric vein resection during pancreatectomy for cancer. Br J Surg 93(6):662–673

    Article  PubMed  CAS  Google Scholar 

  6. Michalski CW, Kleeff J, Wente MN et al (2007) Systematic review and meta-analysis of standard and extended lymphadenectomy in pancreaticoduodenectomy for pancreatic cancer. Br J Surg 94(3):265–273

    Article  PubMed  CAS  Google Scholar 

  7. Stitzenberg KB, Watson JC, Roberts A et al (2008) Survival after pancreatectomy with major arterial resection and reconstruction. Ann Surg Oncol 15(5):1399–1406

    Article  PubMed  Google Scholar 

  8. Lightner AM, Glasgow RE, Jordan TH et al (2004) Pancreatic resection in the elderly. J Am Coll Surg 198(5):697–706

    Article  PubMed  Google Scholar 

  9. Birkmeyer JD, Siewers AE, Finlayson EV et al (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346(15):1128–1137

    Article  PubMed  Google Scholar 

  10. Diener MK, Knaebel HP, Heukaufer C et al (2007) A systematic review and meta-analysis of pylorus-preserving versus classical pancreaticoduodenectomy for surgical treatment of periampullary and pancreatic carcinoma. Ann Surg 245(2):187–200

    Article  PubMed  Google Scholar 

  11. Tran KT, Smeenk HG, van Eijck CH et al (2004) Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg 240(5):738–745

    Article  PubMed  Google Scholar 

  12. Hartel M, Wente MN, Hinz U et al (2005) Effect of antecolic reconstruction on delayed gastric emptying after the pylorus-preserving Whipple procedure. Arch Surg 140(11):1094–1099

    Article  PubMed  Google Scholar 

  13. Kleeff J, Diener MK, Z’Graggen K et al (2007) Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg 245(4):573–582

    Article  PubMed  Google Scholar 

  14. Knaebel HP, Diener MK, Wente MN et al (2005) Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg 92(5):539–546

    Article  PubMed  CAS  Google Scholar 

  15. Diener M, Knaebel H, Witte S et al (2008) DISPACT trial: a randomized controlled trial to compare two different surgical techniques of DIStal PAnCreaTectomy – study rationale and design. Clin Trials 5(5):534–545

    Article  PubMed  CAS  Google Scholar 

  16. Muller MW, Friess H, Kleeff J et al (2007) Is there still a role for total pancreatectomy? Ann Surg 246(6):966–974, discussion 74–75

    Article  PubMed  Google Scholar 

  17. Weitz J, Kienle P, Schmidt J et al (2007) Portal vein resection for advanced pancreatic head cancer. J Am Coll Surg 204(4):712–716

    Article  PubMed  Google Scholar 

  18. Shoup M, Conlon KC, Klimstra D, Brennan MF (2003) Is extended resection for adenocarcinoma of the body or tail of the pancreas justified? J Gastrointest Surg 7(8):946–952, discussion 52

    Article  PubMed  Google Scholar 

  19. Manabe T, Ohshio G, Baba N et al (1989) Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas. Cancer 64(5):1132–1137

    Article  PubMed  CAS  Google Scholar 

  20. Nagakawa T, Kobayashi H, Ueno K et al (1993) The pattern of lymph node involvement in carcinoma of the head of the pancreas. A histologic study of the surgical findings in patients undergoing extensive nodal dissections. Int J Pancreatol 13(1):15–22

    PubMed  CAS  Google Scholar 

  21. Reiser-Erkan C, Gaa J, Kleeff J (2008) T1 Pancreatic cancer with lymph node metastasis and perineural invasion of the celiac trunk. Clin Gastroenterol Hepatol 6(11):e41–42

    Article  PubMed  Google Scholar 

  22. Shrikhande SV, Kleeff J, Reiser C et al (2007) Pancreatic resection for M1 pancreatic ductal adenocarcinoma. Ann Surg Oncol 14(1):118–127

    Article  PubMed  Google Scholar 

  23. Schniewind B, Bestmann B, Kurdow R et al (2006) Bypass surgery versus palliative pancreaticoduodenectomy in patients with advanced ductal adenocarcinoma of the pancreatic head, with an emphasis on quality of life analyses. Ann Surg Oncol 13(11):1403–1411

    Article  PubMed  CAS  Google Scholar 

  24. Koninger J, Wente MN, Muller MW et al (2007) Surgical palliation in patients with pancreatic cancer. Langenbecks Arch Surg 392(1):13–21

    Article  PubMed  Google Scholar 

  25. Kleeff J, Reiser C, Hinz U et al (2007) Surgery for recurrent pancreatic ductal adenocarcinoma. Ann Surg 245(4):566–572

    Article  PubMed  Google Scholar 

  26. Kleeff J, Friess H, Büchler MW (2007) Neoadjuvant therapy for pancreatic cancer. Br J Surg 94:261–262

    Article  PubMed  CAS  Google Scholar 

  27. Brunner TB, Grabenbauer GG, Meyer T et al (2007) Primary resection versus neoadjuvant chemoradiation followed by resection for locally resectable or potentially resectable pancreatic carcinoma without distant metastasis. A multi-centre prospectively randomised phase II-study of the Interdisciplinary Working Group Gastrointestinal Tumours (AIO, ARO, and CAO). BMC Cancer 7:41

    Article  PubMed  Google Scholar 

  28. Neoptolemos JP, Stocken DD, Friess H et al (2004) A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 350(12):1200–1210

    Article  PubMed  CAS  Google Scholar 

  29. Oettle H, Post S, Neuhaus P et al (2007) Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 297(3):267–277

    Article  PubMed  CAS  Google Scholar 

  30. Stocken DD, Buchler MW, Dervenis C et al (2005) Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer. Br J Cancer 92(8):1372–1381

    Article  PubMed  CAS  Google Scholar 

  31. Picozzi VJ, Kozarek RA, Traverso LW (2003) Interferon-based adjuvant chemoradiation therapy after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am J Surg 185(5):476–480

    Article  PubMed  Google Scholar 

  32. Schmidt J, Jager D, Hoffmann K et al (2007) Impact of interferon-alpha in combined chemoradioimmunotherapy for pancreatic adenocarcinoma (CapRI): first data from the immunomonitoring. J Immunother 30(1):108–115

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    M. Loos, H. Friess &  J. Kleeff

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  1. M. Loos
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  2. H. Friess
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  3. J. Kleeff
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Correspondence to J. Kleeff.

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Loos, M., Friess, H. & Kleeff, J. Chirurgie maligner Pankreastumoren. Radiologe 49, 137–143 (2009). https://doi.org/10.1007/s00117-008-1752-4

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