Skip to main content
SpringerLink
Log in

Pankreaskarzinom im hohen Alter

Leitlinien und individualisierte Therapie

Pancreatic cancer in the elderly

Guidelines and individualized therapy

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

An Erratum to this article was published on 13 June 2013

Zusammenfassung

Der deutliche Zuwachs der älteren Bevölkerung der westlichen Welt bedeutet in den kommenden Jahren konsekutiv einen steigenden Anteil an Patienten mit der Diagnose Pankreaskarzinom. Bis zum Jahr 2020 ist mit einer 20%igen Zunahme an Patienten jenseits des 65. Lebensjahrs zu rechnen. Damit rückt das Management alter bzw. hochbetagter Patienten auch in der Chirurgie immer mehr in den Mittelpunkt, was ein strategisches Umdenken chirurgischer Behandlungsindikationen unter Berücksichtigung der Machbarkeit und der Sinnhaftigkeit erfordert. Das duktale Adenokarzinom des Pankreas hat eine äußerst schlechte Prognose mit einer insgesamten 5-Jahres-Überlebensrate < 5 % trotz sukzessivem Fortschritt in der interdisziplinären Behandlung. Die chirurgische Resektion bietet nach wie vor die einzige Chance auf ein verlängertes Überleben, ist jedoch technisch anspruchsvoll und weiterhin mit deutlicher Morbidität verbunden. Insbesondere für die Qualität der chirurgischen Therapie der mittlerweile interdisziplinären Behandlung des Pankreaskarzinoms ist die Anbindung an ein Zentrum mit nachweisbar besseren Ergebnissen verbunden. Wenige retrospektive Datenanalysen haben sich bis heute mit dem perioperativen und dem Langzeitverlauf ausgedehnter Pankreastumorresektionen im höheren Alter befasst. Verfügbare Daten sprechen jedoch für ein radikales chirurgisches Vorgehen auch jenseits des 75. Lebensjahres.

Abstract

The considerable increase of the aged population in western civilisation within the next years will result in a rising incidence of pancreatic cancer. Until the year 2020 an increment of 20  % of patients beyond 65 years old can be anticipated. Therefore, the focus will be on management of old and geriatric surgical patients leading to strategical re-evaluation of surgical indications under critical consideration of feasibility and purpose. Even under modern interdisciplinary therapy concepts the prognosis of ductal adenocarcinoma of the pancreas remains poor with an overall 5-year survival rate of less than 5  %. The surgical resection is still considered as the only potential curative treatment option with extended life expectancy; however, it is technically demanding and furthermore associated with significant morbidity. In particular, the quality of surgery of the now interdisciplinary therapy of pancreatic cancer is markedly improved when performed at a high-volume centres. Until now only a few retrospective data analyses evaluating the perioperative and long-term outcome after pancreatic tumor resections in geriatric patients exist. The available results, however, support radical surgical procedures even beyond the age of 75 years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Robert Koch-Institut, die Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V. (Hrsg) (2012) Krebs in Deutschland 2007/2008. Berlin

  2. Adler G, Seufferlein T, Bischoff SC et al (2007) S3-Guidelines „Exocrine pancreatic cancer“ 2007. Z Gastroenterol 45:487–523

    Article  PubMed  CAS  Google Scholar 

  3. Bachellier P, Nakano H, Oussoultzoglou PD et al (2001) Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile? Am J Surg 182:120–129

    Article  PubMed  CAS  Google Scholar 

  4. Ballarin R, Spaggiari M, Di Benedetto F et al (2009) Do not deny pancreatic resection to elderly patients. J Gastrointest Surg 13:341–348

    Article  PubMed  Google Scholar 

  5. Birkmeyer JD, Sun Y, Wong SL et al (2007) Hospital volume and late survival after cancer surgery. Ann Surg 245:777–783

    Article  PubMed  Google Scholar 

  6. Brozzetti S, Mazzoni G, Miccini M et al (2006) Surgical treatment of pancreatic head carcinoma in elderly patients. Arch Surg 141:137–142

    Article  PubMed  Google Scholar 

  7. Bruns CJ, Jauch KW (2007) Surgical treatment of pancreatic cancer. Dtsch Med Wochenschr 132:798–802

    Article  PubMed  CAS  Google Scholar 

  8. Butturini G, Stocken DD, Wente MN et al (2008) Influence of resection margins and treatment on survival in patients with pancreatic cancer: meta-analysis of randomized controlled trials. Arch Surg 143:75–83

    Article  PubMed  Google Scholar 

  9. Casadei R, Zanini N, Morselli-Labate AM et al (2006) Prognostic factors in periampullary and pancreatic tumor resection in elderly patients. World J Surg 30:1992–2002

    Article  PubMed  CAS  Google Scholar 

  10. Christein JD, Kendrick ML, Iqbal CW et al (2005) Distal pancreatectomy for resectable adenocarcinoma of the body and tail of the pancreas. J Gastrointest Surg 9:922–927

    Article  PubMed  Google Scholar 

  11. Cioc AM, Ellison EC, Proca DM et al (2002) Frozen section diagnosis of pancreatic lesions. Arch Pathol Lab Med 126:1169–1173

    PubMed  Google Scholar 

  12. DiCarlo V, Balzano G, Zerbi A et al (1998) Pancreatic cancer resection in elderly patients. Br J Surg 85:607–610

    Article  PubMed  CAS  Google Scholar 

  13. 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 245:187–200

    Article  PubMed  Google Scholar 

  14. Esposito I, Kleeff J, Bergmann F et al (2008) Most pancreatic cancer resections are R1 resections. Ann Surg Oncol 15:1651–1660

    Article  PubMed  Google Scholar 

  15. Fong Y, Blumgart LH, Fortner JG et al (1995) Pancreatic or liver resection for malignancy is safe and effective for the elderly. Ann Surg 222:426–434

    PubMed  CAS  Google Scholar 

  16. Fuhrman GM, Leach SD, Staley CA et al (1996) Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric-portal vein confluence. Pancreatic Tumor Study Group. Ann Surg 223:154–162

    Article  PubMed  CAS  Google Scholar 

  17. Glanemann M, Shi B, Liang F et al (2008) Surgical strategies for treatment of malignant pancreatic tumors: extended, standard or local surgery? World J Surg Oncol 6:123

    Article  PubMed  Google Scholar 

  18. Kang CM, Kim JY, Choi GH et al (2007) Pancreaticoduodenectomy of pancreatic ductal adenocarcinoma in the elderly. Yonsei Med J 48:488–494

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  20. Kleespies A, Rentsch M, Seeliger H et al (2009) Blumgart anastomosis for pancreaticojejunostomy minimizes severe complications after pancreatic head resection. Br J Surg 96:741–750

    Article  PubMed  CAS  Google Scholar 

  21. Lahat G, Sever R, Lubezky N et al (2011) Pancreatic cancer: surgery is a feasible therapeutic option for elderly patients. World J Surg Oncol 9:10

    Article  PubMed  Google Scholar 

  22. Li B, Chen FZ, Ge XH et al (2004) Pancreatoduodenectomy with vascular reconstruction in treating carcinoma of the pancreatic head. Hepatobiliary Pancreat Dis Int 3:612–615

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  24. Luttges J, Zamboni G, Kloppel G (1999) Recommendation for the examination of pancreaticoduodenectomy specimens removed from patients with carcinoma of the exocrine pancreas. A proposal for a standardized pathological staging of pancreaticoduodenectomy specimens including a checklist. Dig Surg 16:291–296

    Article  PubMed  CAS  Google Scholar 

  25. Makary MA, Winter JM, Cameron JL et al (2006) Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg 10:347–356

    Article  PubMed  Google Scholar 

  26. Mangano DT, Goldman L (1995) Preoperative assessment of patients with known or suspected coronary disease. N Engl J Med 333:1750–1756

    Article  PubMed  CAS  Google Scholar 

  27. Riall TS (2009) What is the effect of age on pancreatic resection? Adv Surg 43:233–249

    Article  PubMed  Google Scholar 

  28. Sakata E, Shirai Y, Yokoyama N et al (2006) Clinical significance of lymph node micrometastasis in ampullary carcinomA. World J Surg 30:985–991

    Article  PubMed  Google Scholar 

  29. Schnelldorfer T, Ware AL, Sarr MG et al (2008) Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg 247:456–462

    Article  PubMed  Google Scholar 

  30. Scurtu R, Bachellier P, Oussoultzoglou E et al (2006) Outcome after pancreaticoduodenectomy for cancer in elderly patients. J Gastrointest Surg 10:813–822

    Article  PubMed  Google Scholar 

  31. Seeliger H, Christians S, Angele MK et al (2010) Risk factors for surgical complications in distal pancreatectomy. Am J Surg 200:311–317

    Article  PubMed  Google Scholar 

  32. Shimada K, Sakamoto Y, Sano T et al (2006) Prognostic factors after distal pancreatectomy with extended lymphadenectomy for invasive pancreatic adenocarcinoma of the body and tail. Surgery 139:288–295

    Article  PubMed  Google Scholar 

  33. Shoup M, Conlon KC, Klimstra D et al (2003) Is extended resection for adenocarcinoma of the body or tail of the pancreas justified? J Gastrointest Surg 7:946–952

    Article  PubMed  Google Scholar 

  34. Siegel R, Naishadham D, Jemal A (2012) Cancer statistics, 2012. CA Cancer J Clin 62:10–29

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  36. Sohn TA, Yeo CJ, Cameron JL et al (1998) Should pancreaticoduodenectomy be performed in octogenarians? J Gastrointest Surg 2:207–216

    Article  PubMed  CAS  Google Scholar 

  37. Spencer MP, Sarr MG, Nagorney DM (1990) Radical pancreatectomy for pancreatic cancer in the elderly. Is it safe and justified? Ann Surg 212:140–143

    Article  PubMed  CAS  Google Scholar 

  38. Takada T, Yasuda H, Amano H et al (1997) Simultaneous hepatic resection with pancreato-duodenectomy for metastatic pancreatic head carcinoma: does it improve survival? Hepatogastroenterology 44:567–573

    PubMed  CAS  Google Scholar 

  39. 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 91:586–594

    Article  PubMed  CAS  Google Scholar 

  40. Yekebas EF, Bogoevski D, Cataldegirmen G et al (2008) En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels: perioperative outcome and long-term survival in 136 patients. Ann Surg 247:300–309

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, LMU München,Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    H. Nieß, A. Kleespies, J. Andrassy, P. Pratschke, M.K. Angele, M. Guba, K.-W. Jauch &  C.J. Bruns

Authors
  1. H. Nieß
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Kleespies
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Andrassy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Pratschke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M.K. Angele
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Guba
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K.-W. Jauch
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C.J. Bruns
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C.J. Bruns.

Additional information

Ein Erratum zu diesem Beitrag ist unter http://dx.doi.org/10.1007/s00104-013-2525-9 zu finden.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nieß, H., Kleespies, A., Andrassy, J. et al. Pankreaskarzinom im hohen Alter. Chirurg 84, 291–295 (2013). https://doi.org/10.1007/s00104-012-2455-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-012-2455-y

Schlüsselwörter

Keywords

Search

Navigation