Advertisement

Stellenwert der Metastasenchirurgie beim fortgeschrittenen Pankreaskarzinom

  • Christiane BrunsEmail author
  • Florian Gebauer
  • Florian Scheufele
  • Helmut Friess
Leitthema
  • 15 Downloads

Zusammenfassung

Hintergrund

Entsprechend den aktuell geltenden Leitlinien werden resezierende Verfahren im metastasierten Stadium beim Pankreaskarzinom nicht empfohlen. In der klinischen Praxis werden Tumor- und Metastasenresektionen jedoch in individuellen Einzelfällen durchgeführt.

Ziel

Diese Übersichtsarbeit fasst die aktuell vorhandene Evidenz anhand der veröffentlichten Studienlage zusammen.

Material und Methoden

Eine systematische Literaturrecherche (PUBMED und MEDLINE) zum Thema resezierender Eingriffe im metastasierten Stadium des Pankreaskarzinoms wurde durchgeführt

Ergebnisse

Insgesamt stellt sich das Evidenzniveau als schwach dar, es sind aktuell keine prospektiven Studien zu diesem Thema verfügbar. Die vorhandenen retrospektiven Arbeiten zeigen eine technische Machbarkeit synchroner Tumor- und Metastasenresektionen mit möglicherweise onkologischen Vorteilen für spezifische Patientensubgruppen.

Schlussfolgerung

Das Evidenzniveau ist zu schwach, um grundsätzliche Therapieentscheidungen für Patienten im oligometastasierten Stadium ableiten zu können. Prospektive Studien zu dem Thema sind notwendig, um feststellen zu können, ob eine Metastasenchirurgie, eingebettet in multimodale Therapiekonzepte, sinnvoll durchzuführen ist.

Schlüsselwörter

Metastasenresektion Oligometastasierung Hepatische Metastasen Resektion Multimodale Therapie 

Impact of surgery of metastases in advanced pancreatic cancer

Abstract

Background

According to the current guidelines surgery is not recommended in the metastasized stage of pancreatic cancer; however, in clinical practice surgery including resection of the primary tumor and metastases is performed in individual cases.

Aim

This review article summarizes the currently available evidence based on the published studies.

Material and methods

A systematic search in MEDLINE and PubMed was performed with respect to metastasized pancreatic cancer and surgical resection.

Results

The evidence level is not sufficient to answer the question as to whether patients in an oligometastasized stage should be operated on or not. The available retrospective studies show a technical feasibility of synchronous resection of the primary tumor and metastases with a possibly beneficial oncological outcome for specific patient groups.

Conclusion

Based on the currently available evidence, a general treatment decision for patients in an oligometastatic stage cannot be derived. Therefore, prospective clinical trials are necessary to answer the question of which patients could benefit from a combined resection of primary tumor and metastases embedded in a multimodal treatment concept.

Keywords

Resection of metastases Oligometastasis Hepatic metastasis Resection Multimodal therapy 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

C. Bruns, F. Gebauer, F. Scheufele und H. Friess geben an, dass in Hinblick auf diese Arbeit kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren, nur eine Zusammenstellung der vorhandenen Literatur.

Literatur

  1. 1.
    Siegel RL, Miller KD, Jemal A (2017) Cancer Statistics, 2017. CA Cancer J Clin 67(1):7–30CrossRefGoogle Scholar
  2. 2.
    Rahib L, Smith BD et al (2014) Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res 74(11):2913–2921CrossRefGoogle Scholar
  3. 3.
    Werner J, Combs SE et al (2013) Advanced-stage pancreatic cancer: therapy options. Nat Rev Clin Oncol 10(6):323–333CrossRefGoogle Scholar
  4. 4.
    Hartwig W, Strobel O et al (2013) CA19-9 in potentially resectable pancreatic cancer: perspective to adjust surgical and perioperative therapy. Ann Surg Oncol 20(7):2188–2196CrossRefGoogle Scholar
  5. 5.
    Gillen S, Schuster T et al (2010) Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med 7(e1000267):4Google Scholar
  6. 6.
    Morgan DE, Waggoner CN et al (2010) Resectability of pancreatic adenocarcinoma in patients with locally advanced disease downstaged by preoperative therapy: a challenge for MDCT. AJR Am J Roentgenol 194(3):615–622CrossRefGoogle Scholar
  7. 7.
    Seufferlein T, Porzner M et al (2013) S3-guideline exocrine pancreatic cancer. Z Gastroenterol 51(12):1395–1440CrossRefGoogle Scholar
  8. 8.
    Tempero MA, Malafa MP et al (2014) Pancreatic adenocarcinoma, version 2.2014: featured updates to the NCCN guidelines. J Natl Compr Canc Netw 12(8):1083–1093CrossRefGoogle Scholar
  9. 9.
    Fahy BN, D’Angelica M et al (2009) Synchronous hepatic metastases from colon cancer: changing treatment strategies and results of surgical intervention. Ann Surg Oncol 16(2):361–370CrossRefGoogle Scholar
  10. 10.
    Martin RC 2nd, Augenstein V et al (2009) Simultaneous versus staged resection for synchronous colorectal cancer liver metastases. J Am Coll Surg 208(5):842–850 (discussion 850–2)CrossRefGoogle Scholar
  11. 11.
    Klempnauer J, Ridder GJ et al (1996) Is liver resection in metastases of exocrine pancreatic carcinoma justified? Chirurg 67(4):366–370PubMedGoogle Scholar
  12. 12.
    Gleisner AL, Assumpcao L, Cameron JL, Wolfgang CL, Choti MA, Herman JM, Schulick RD, Pawlik TM (2007) Is resection of periampullary or pancreatic adenocarcinoma with synchronous hepatic metastasis justified? Cancer 110(11):2484–2492CrossRefGoogle Scholar
  13. 13.
    Shrikhande SV, Kleeff J et al (2007) Pancreatic resection for M1 pancreatic ductal adenocarcinoma. Ann Surg Oncol 14(1):118–127CrossRefGoogle Scholar
  14. 14.
    de Jong MC, Tsai S et al (2010) Safety and efficacy of curative intent surgery for peri-ampullary liver metastasis. J Surg Oncol 102(3):256–263CrossRefGoogle Scholar
  15. 15.
    Klein F, Puhl G et al (2012) The impact of simultaneous liver resection for occult liver metastases of pancreatic adenocarcinoma. Gastroenterol Res Pract 2012:939350CrossRefGoogle Scholar
  16. 16.
    Tachezy M, Gebauer F et al (2016) Synchronous resections of hepatic oligometastatic pancreatic cancer: Disputing a principle in a time of safe pancreatic operations in a retrospective multicenter analysis. Surgery 160(1):136–144CrossRefGoogle Scholar
  17. 17.
    Hackert T, Niesen W et al (2017) Radical surgery of oligometastatic pancreatic cancer. Eur J Surg Oncol 43(2):358–363CrossRefGoogle Scholar
  18. 18.
    van Roessel S, Kasumova GG et al (2018) International validation of the eighth edition of the American joint committee on cancer (AJCC) TNM staging system in patients with Resected pancreatic cancer. JAMA Surg 153:e183617CrossRefGoogle Scholar
  19. 19.
    Paiella S, Sandini M et al (2016) The prognostic impact of para-aortic lymph node metastasis in pancreatic cancer: a systematic review and meta-analysis. Eur J Surg Oncol 42(5):616–624CrossRefGoogle Scholar
  20. 20.
    Komo T, Murakami Y et al (2016) Prognostic impact of para-aortic lymph node Micrometastasis in pancreatic ductal Adenocarcinoma. Ann Surg Oncol 23(6):2019–2027CrossRefGoogle Scholar
  21. 21.
    Sho M, Murakami Y et al (2015) Postoperative prognosis of pancreatic cancer with para-aortic lymph node metastasis: a multicenter study on 822 patients. J Gastroenterol 50(6):694–702CrossRefGoogle Scholar
  22. 22.
    Disibio G, French SW (2008) Metastatic patterns of cancers: results from a large autopsy study. Arch Pathol Lab Med 132(6):931–939PubMedGoogle Scholar
  23. 23.
    Kneuertz PJ, Cunningham SC et al (2011) Palliative surgical management of patients with unresectable pancreatic adenocarcinoma: trends and lessons learned from a large, single institution experience. J Gastrointest Surg 15(11):1917–1927CrossRefGoogle Scholar
  24. 24.
    Michalski CW, Erkan M et al (2008) Resection of primary pancreatic cancer and liver metastasis: a systematic review. Dig Surg 25(6):473–480CrossRefGoogle Scholar
  25. 25.
    Nikfarjam M, Shereef S et al (2009) Survival outcomes of patients with colorectal liver metastases following hepatic resection or ablation in the era of effective chemotherapy. Ann Surg Oncol 16(7):1860–1867CrossRefGoogle Scholar
  26. 26.
    Hua YQ, Wang P et al (2017) Radiofrequency ablation for hepatic oligometastatic pancreatic cancer: an analysis of safety and efficacy. Pancreatology 17(6):967–973CrossRefGoogle Scholar
  27. 27.
    Crippa S, Bittoni A et al (2016) Is there a role for surgical resection in patients with pancreatic cancer with liver metastases responding to chemotherapy? Eur J Surg Oncol 42(10):1533–1539CrossRefGoogle Scholar
  28. 28.
    Kandel P, Wallace MB et al (2018) Survival of patients with oligometastatic pancreatic ductal adenocarcinoma treated with combined modality treatment including surgical resection: a pilot study. J Pancreat Cancer 4(1):88–94CrossRefGoogle Scholar
  29. 29.
    Arnaoutakis GJ, Rangachari D et al (2011) Pulmonary resection for isolated pancreatic adenocarcinoma metastasis: an analysis of outcomes and survival. J Gastrointest Surg 15(9):1611–1617CrossRefGoogle Scholar
  30. 30.
    Kruger S, Haas M et al (2016) Isolated pulmonary metastases define a favorable subgroup in metastatic pancreatic cancer. Pancreatology 16(4):593–598CrossRefGoogle Scholar
  31. 31.
    Nakajima M, Ueno T et al (2017) Novel indications for surgical resection of metachronous lung metastases from pancreatic cancer after curative resection. J Clin Gastroenterol 51(5):e34–e38CrossRefGoogle Scholar
  32. 32.
    Conroy T, Desseigne F et al (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364(19):1817–1825CrossRefGoogle Scholar
  33. 33.
    Wang-Gillam A, Li CP et al (2016) Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial. Lancet 387(10018):545–557CrossRefGoogle Scholar
  34. 34.
    Von Hoff DD, Ervin T et al (2013) Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 369(18):1691–1703CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  • Christiane Bruns
    • 1
    Email author
  • Florian Gebauer
    • 1
  • Florian Scheufele
    • 2
  • Helmut Friess
    • 2
  1. 1.Klinik für Allgemein‑, Viszeral und TumorchirurgieUniklinik KölnKölnDeutschland
  2. 2.Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Medizinische FakultätTechnische Universität MünchenMünchenDeutschland

Personalised recommendations