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Die duodenumerhaltende Pankreaskopfresektion

Eine lokale parenchymsparende Therapie benigner und prämaligner Tumoren des Pankreaskopfes
  • Hans G. BegerEmail author
  • B. Mayer
  • B. Poch
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Zusammenfassung

Hintergrund

Im Gegensatz zur Kausch-Whipple-Operation (PD) geht die parenchymsparende lokale Resektion des Pankreaskopfes (DEPKR) mit Gewebserhaltung und Erhaltung der metabolischen Funktionen des Pankreas einher.

Ziel

Die DEPKR für benigne Neoplasien ist nach Ergebnissen kontrollierter, prospektiv-klinischer Studien assoziiert mit geringem Operationsrisiko, der Erhaltung des Glukosestoffwechsels und der exokrinen Pankreasfunktionen. Die Übersichtsarbeit fasst die Ergebnisse nach Anwendung der DEPKR bei chronischer Pankreatitis und benignen Tumoren des Pankreaskopfes und die klinische Evidenz der Ergebnisse zusammen.

Material und Methoden

Das Literaturreview umfasst Ergebnisse aller prospektiven, prospektiv-kontrollierten und randomisierten klinischen Studien und Metaanalysen, die DEPKR und PD bei chronischer Pankreatitis sowie benignen Neoplasien des Pankreas vergleichend analysieren.

Ergebnisse

Der Vergleich von DEPKR und PD ergibt, dass die parenchymsparende lokale Pankreaskopfresektion assoziiert ist mit kürzerer Operationszeit, kürzerer ICU- und Krankenhausliegezeit, geringerem intraoperativem Blutverlust, niedriger Frequenz von Magenentleerungsstörungen und Erhaltung der metabolischen Pankreasfunktionen. Bei chronischer Pankreatitis waren Häufigkeit von Pankreasfisteln, Krankenhausletalität und Lebensqualität vergleichbar niedrig nach beiden Operationsverfahren. Die DEPKR bei benignen und prämalignen Neoplasien bei Erwachsenen und Kindern und bei periampullären Low-risk-Malignomen hat den Vorteil einer langzeitpersistierenden Erhaltung der endokrinen und exokrinen Pankreasfunktionen und der gastrointestinalen Motilität.

Schlussfolgerung

Die DEPKR für benigne, prämaligne, zystische und neuroendokrine Neoplasien des Pankreaskopfes ist assoziiert mit wesentlichen Vorteilen im frühen postoperativen Verlauf sowie der Erhaltung gastrointestinaler und pankreatischer Funktionen.

Schlüsselwörter

Benigne Pankreastumoren Pankreaskopftumoren Prämaligne Dysplasien Neuroendocrine Tumoren Chronische Pankreatitis 

Duodenum-preserving pancreatic head resection

A local parenchyma-sparing treatment of benign and premalignant tumors of the pancreatic head

Abstract

Background

In contrast to the Kausch-Whipple procedure (pancreatoduodenectomy) duodenum-preserving pancreatic head resection (DPPHR) is associated with tissue sparing and maintenance of the pancreatic metabolic functions.

Aim

According to the results of controlled clinical trials the DPPHR procedure for benign pancreatic neoplasms is associated with low surgery-related complications and maintenance of glucose metabolism and exocrine pancreatic functions. This overview summarizes the clinical results of the use of DPPHR for chronic pancreatitis and benign tumors of the pancreatic head and the status of the clinical evidence of the results.

Material and methods

The literature review included the results of all prospective, prospective-controlled and randomized clinical trials and meta-analyses, which analyzed and compared pancreatoduodenectomy and DPPHR for chronic pancreatitis and benign neoplasms of the pancreas.

Results

Compared to pancreatoduodenectomy, DPPHR exhibits significantly shorter times for surgery, shorter intensive care unit and hospital stays, lower intraoperative blood loss, lower frequency of disorders of gastric emptying and preservation of pancreatic functions. Chronic pancreatitis pancreatic fistula rates, hospital mortality and quality of life were equally low after both operations. The use of DPPHR for benign, premalignant neoplasms in adults and children and for periampullary low-risk malignancies has the advantage of a long-lasting preservation of endocrine and exocrine pancreatic functions and gastrointestinal motility.

Conclusion

The use of DPPHR for benign, premalignant, cystic and neuroendocrine neoplasms of the pancreatic head is associated with major advantages in the early postoperative course and preservation of gastrointestinal and pancreatic functions.

Keywords

Benign pancreatic tumors Pancreatic head tumors Premalignant dysplasia Neuroendocrine tumors Chronic pancreatitis 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

H.G. Beger, B. Mayer und B. Poch geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.c/o Universität UlmUlmDeutschland
  2. 2.Institut für Epidemiologie und Medizinische BiometrieUniversität UlmUlmDeutschland
  3. 3.Zentrum für onkologische, endokrinologische und minimalinvasive ChirurgieDonau-KlinikumNeu-UlmDeutschland

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