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Minimal-invasive Resektion neuroendokriner Pankreastumoren

Minimally invasive resection of neuroendocrine pancreatic tumors

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Zusammenfassung

Neuroendokrine Pankreastumoren (NPT) sind eine heterogene Gruppe von Tumoren mit einer Inzidenz von ca. 0,1–0,4/100.000/Jahr. Sie machen ca. 2–4% aller Pankreasneoplasien aus. Aufgrund ihrer meist geringen Größe eignen sich einige von ihnen gut für ein laparoskopisches Vorgehen. Prinzipielle Voraussetzungen hierfür sind eine präoperative Lokalisation des Tumors, die Möglichkeit des laparoskopischen Ultraschalls und Erfahrung des Operateurs auf dem Gebiet der endokrinen Pankreaschirurgie sowie mit anspruchsvollen laparoskopischen Operationstechniken. Bei Hinweisen auf Malignität sollte dem konventionellen Vorgehen der Vorzug gegeben werden.

Für ein laparoskopisches Vorgehen gut geeignet sind Insulinome sowie kleine (<3 cm) nichtfunktionelle NPT (nfNPT), die im Pankreaskorpus und -schwanz oder ventral im Pankreaskopf ohne direkten Kontakt zum Pankreashauptgang oder zur Vena portae gelegen sind. Auch Insulinome und nfNPT im Rahmen der multiplen endokrinen Neoplasie Typ 1 können eine laparoskopische milzerhaltende Pankreaslinksresektion rechtfertigen. Nicht geeignet für ein laparoskopisches Vorgehen sind Gastrinome sowie die sehr seltenen, aber fast immer malignen Glukagonome und VIPome („vasoactive intestinal peptide-producing tumors“).

Abstract

Pancreatic endocrine tumors (PET) are a heterogeneous group of lesions with an annual incidence of 0.1 to 0.4 per 100,000. They account for 2–4% of pancreatic neoplasms. Due to their mostly small size, some are suited to a laparoscopic approach. Preoperative localization, intraoperative laparoscopic ultrasonography, and considerable experience in pancreatic endocrine surgery and sophisticated laparoscopic techniques are essential for successful laparoscopic treatment of these tumors. If definite or highly suspicious signs of malignancy occur, a conventional open approach should be preferred. Insulinomas and small nonfunctioning PET in the pancreatic body or tail or near the surface of the pancreatic head and not in contact with the portal vein or the main pancreatic duct are suited to a laparoscopic approach. Patients with MEN1 who have insulinomas or small nonfunctioning PET may also benefit from a laparoscopic spleen-preserving distal pancreatic resection. Neither sporadic and MEN1-associated gastrinomas nor the very rare glucagonomas and vasoactive intestinal peptide-producing tumors (vipomas), which are often large and malignant, should also be tackled laparoscopically.

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  1. Klinik für Visceral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland

    P. Langer, V. Fendrich & D.K. Bartsch

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  1. P. Langer
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  2. V. Fendrich
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  3. D.K. Bartsch
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Correspondence to P. Langer.

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Langer, P., Fendrich, V. & Bartsch, D. Minimal-invasive Resektion neuroendokriner Pankreastumoren. Chirurg 80, 105–112 (2009). https://doi.org/10.1007/s00104-008-1613-8

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