Skip to main content

Pankreaskarzinom

Pancreatic carcinoma

Zusammenfassung

Das Pankreaskarzinom zeichnet sich durch ein aggressives Wachstumsverhalten aus und liegt in Deutschland bei Frauen an 4. Stelle, bei Männern an 5. Stelle der tumorbedingten Todesfälle. Durch das späte Auftreten von Symptomen und des bei Diagnosestellung häufig schon fortgeschrittenen Tumorstadiums, entspricht die Inzidenzrate weitgehend der jährlichen Mortalitätsrate. Histopathologisch nimmt das duktale Adenokarzinom mit etwa 85% aller Pankreaskarzinome die Hauptrolle ein. Die chirurgische Therapie stellt die wichtigste Therapieoption des Pankreaskarzinoms dar, wenn auch nur ein Teil der Patienten unter potenziell kurativem Ansatz resektabel ist. Auch bei potenziell kurativer Resektion gilt die Langzeitprognose des Pankreaskarzinoms als ungünstig, durch neue multimodale Therapieansätze kann jedoch eine Prognoseverbesserung erreicht werden. Zusätzlich haben Fortschritte in der chirurgischen Technik und im perioperativen Management die operative Morbidität und Mortalität – insbesondere an „High-volume-Zentren“ – deutlich reduziert.

Abstract

Aggressive tumor biology is the main characteristic of pancreatic cancer, in Germany the fourth leading cause of cancer death for females and the fifth leading cause for males. Due to late occurrence of symptoms and aggressive tumor growth, pancreatic cancer has equal incidence and mortality. Most malignant pancreatic tumours are ductal adenocarcinomas (85%). Surgical resection is the main therapeutic modality for pancreatic cancer, even though only a fraction of patients can undergo complete resection. Prognosis of pancreatic cancer remains poor even in completely resected patients; however, multimodal regimes might improve prognosis. Additionally, advances in surgical technique and perioperative management have reduced operative mortality and morbidity, especially in high-volume centers.

This is a preview of subscription content, access via your institution.

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10

Literatur

  1. 1.

    Adler G, Seufferlein T, Bischoff SC et al. (2007) S3-Leitlinie Exokrines Pankreaskarzinom. Z Gastroenterol 45: 487–523

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Bassi C, Dervenis C, Butturini G et al. (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138: 8–13

    PubMed  Article  Google Scholar 

  3. 3.

    Berberat PO, Friess H, Kleeff J et al. (1999) Prevention and treatment of complications in pancreatic cancer surgery. Dig Surg 16: 327–336

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Berberat P, Ingold H, Gulbinas A et al. (2007) Fast track-different implications in pancreatic surgery. J Gastrointest Surg 11: 880–887

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Bramhall SR, Allum WH, Jones AG et al. (1995) Treatment and survival in 13,560 patients with pancreatic cancer, and incidence of the disease, in the West Midlands: an epidemiological study. Br J Surg 82: 111–115

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Büchler MW, Wagner M, Schmied BM et al. (2003) Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg 138: 1310–1314

    PubMed  Article  Google Scholar 

  7. 7.

    Carpelan-Holmstrom M, Nordling S, Pukkala E et al. (2005) Does anyone survive pancreatic ductal adenocarcinoma? A nationwide study re-evaluating the data of the Finnish Cancer Registry. Gut 54: 385–387

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    DeOliveira ML, Winter JM, Schafer M et al. (2006) Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244: 931–937

    PubMed  Article  Google Scholar 

  9. 9.

    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

    PubMed  Article  Google Scholar 

  10. 10.

    Ghaneh P, Costello E, Neoptolemos JP (2007) Biology and management of pancreatic cancer. Gut 56: 1134–1152

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Jemal A, Siegel R, Ward E et al. (2007) Cancer statistics, 2007. CA Cancer J Clin 57: 43–66

    PubMed  Article  Google Scholar 

  12. 12.

    Karpoff HM, Klimstra DS, Brennan MF, Conlon KC (2001) Results of total pancreatectomy for adenocarcinoma of the pancreas. Arch Surg 136: 44–47

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Kleeff J, Diener MK, Z’graggen K et al. (2006) Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg 245: 573–582

    Article  Google Scholar 

  14. 14.

    Kleeff J, Michalski C, Friess H, Büchler MW (2006) Pancreatic cancer: from bench to 5-year survival. Pancreas 33: 111–118

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Knaebel HP, Märten A, Schmidt J et al. (2005) Phase III trial of postoperative cisplatin, interferon alpha-2b, and 5-FU combined with external radiation treatment versus 5-FU alone for patients with resected pancreatic adenocarcinoma – CapRI: study protocol [ISRCTN62866759]. BMC Cancer 5: 37

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Lockhart AC, Rothenberg ML, Berlin JD (2005) Treatment for pancreatic cancer: current therapy and continued progress. Gastroenterology 128: 1642–1654

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    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: 265–273

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Müller M, Friess H, Kleeff J et al. (2007) Is there still a role for total pancreatectomy? Ann Surg (in press)

  19. 19.

    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: 1200–1210

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    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: 267–277

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Sultana A, Smith CT, Cunningham D et al. (2007) Meta-analysis of chemotherapy for locally advanced and metastatic pancreatic cancer. J Clin Oncol 25: 2607–2615

    PubMed  Article  Google Scholar 

  22. 22.

    Tani M, Terasawa H, Kawai M et al. (2006) Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy: results of a prospective, randomized, controlled trial. Ann Surg 243: 316–320

    PubMed  Article  Google Scholar 

  23. 23.

    Traverso LW, Longmire WP Jr (1978) Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet 146: 959–962

    PubMed  CAS  Google Scholar 

  24. 24.

    Tseng JF, Raut CP, Lee JE et al. (2004) Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg 8: 935–949

    PubMed  Article  Google Scholar 

  25. 25.

    Heek NT van, Kuhlmann KF, Scholten RJ et al. (2005) Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg 242: 781–788

    PubMed  Article  Google Scholar 

  26. 26.

    Varadhachary GR, Tamm EP, Abbruzzese JL et al. (2006) Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol 13: 1035–1046

    PubMed  Article  Google Scholar 

  27. 27.

    Verbeke CS, Leitch D, Menon KV et al. (2006) Redefining the R1 resection in pancreatic cancer. Br J Surg 93: 1232–1237

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    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

    PubMed  Article  CAS  Google Scholar 

  29. 29.

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

    PubMed  Article  Google Scholar 

  30. 30.

    Weitz J, Koch M, Friess H, Büchler MW (2004) Impact of volume and specialization for cancer surgery. Dig Surg 21: 253–361

    PubMed  Article  Google Scholar 

  31. 31.

    Weitz J, Koch M, Kleeff J et al. (2004) Operation nach Kausch-Whipple Technik und Ergebnisse. Chirurg 75: 1113–1119

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Weitz J, Kienle P, Büchler MW (2007) Bypass surgery for advanced pancreatic cancer. In: Beger HG, Warshaw AL, Büchler MW et al. (eds) The Pancreas. 2nd edn. Blackwell Science (in press)

  33. 33.

    Wente MN, Shrikhande SV, Muller MW et al. (2007) Pancreaticojejunostomy versus pancreaticogastrostomy: systematic review and meta-analysis. Am J Surg 193: 171–183

    PubMed  Article  Google Scholar 

  34. 34.

    Wente M, Veit J, Bassi C et al. (2007) Postpancreatectomy hemorrhage (PPH)–An International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142: 20–25

    PubMed  Article  Google Scholar 

  35. 35.

    Wente M, Bassi C, Dervenis C et al. (2007) Delayed gastric emptying (DGE) after pancreatic surgery? A suggested definition by the International Study Group of Pancreatic Surgery (ISGPS), Surgery (in press)

  36. 36.

    Winter JM, Cameron JL, Campbell KA et al. (2006) 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg 10: 1199–1210

    PubMed  Article  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Affiliations

Authors

Corresponding author

Correspondence to J. Weitz.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Reissfelder, C., Koch, M., Büchler, M. et al. Pankreaskarzinom. Chirurg 78, 1059–1072 (2007). https://doi.org/10.1007/s00104-007-1412-7

Download citation

Schlüsselwörter

  • Pankreaskarzinom
  • Inzidenz
  • Diagnostik
  • Chirurgische Therapie
  • Pankreatikoduodenektomie
  • Kausch-Whipple-Verfahren

Keywords

  • Diagnostic management
  • Incidence
  • Kausch-Whipple procedure
  • Pancreatic cancer
  • Surgical therapy