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Pankreaskarzinom im hohen Alter

Leitlinien und individualisierte Therapie

Pancreatic cancer in the elderly

Guidelines and individualized therapy

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.

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

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Correspondence to C.J. Bruns.

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

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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

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Schlüsselwörter

  • Leitlinien
  • Chirurgisches Management
  • Pankreaskarzinom
  • Duktales Adenokarzinom
  • Altersabhängiges Risiko

Keywords

  • Guidelines
  • Surgical management
  • Pancreatic cancer
  • Ductal adenocarcinoma
  • Age-related risk