Skip to main content
SpringerLink
Log in

Chirurgie bei isoliertem Lokalrezidiv und metachroner Oligometastasierung beim Pankreaskarzinom

Surgery for isolated local recurrence and metachronous oligometastasis in pancreatic cancer

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Bei den meisten Patienten mit einem Pankreaskarzinom kommt es im Verlauf zu einem Rezidiv, welches entweder lokal oder systemisch im Sinne von Leber- und/oder Lungenmetastasen auftritt. Durch die zunehmende Anwendung multimodaler Therapiekonzepte besteht ein Trend zu zunehmend radikalerer Chirurgie beim Pankreaskarzinom. Die Rolle der Chirurgie in der Rezidivsituation bleibt jedoch kontrovers.

Ziel der Arbeit

Die chirurgischen Optionen bei isoliertem Lokalrezidiv und bei einer metachronen Oligometastasierung beim Pankreaskarzinom werden dargestellt.

Material und Methoden

Es erfolgte hierzu eine selektive Literaturrecherche und Zusammenfassung der derzeitigen Evidenz zur chirurgischen Behandlung.

Ergebnisse

Für die Metastasenchirurgie beim Pankreaskarzinom liegen aktuell keine randomisierten Studien vor. Die vorliegende Datenlage zeigt jedoch eindrücklich, dass insbesondere nach einer operativen Therapie bei Patienten mit einem Lokalrezidiv oder isoliert pulmonalen Metastasen mit geringer Morbidität und Mortalität ein Langzeitüberleben von bis zu 32 bis 47 Monaten nach Metastasektomie erreicht werden kann. Auch bei einer Lebermetastasierung scheinen individuelle Therapiekonzepte, inklusive Resektionen nach systemtherapeutischer Vorbehandlung vielversprechend zu sein. Der größte Überlebensvorteil zeigte sich hier übereinstimmend für alle Lokalisationen bei Patienten mit einem möglichst langen krankheitsfreien Intervall nach der Erstoperation.

Diskussion

Die Behandlung eines isolierten Lokalrezidivs oder einer metachronen Oligometastasierung beim Pankreaskarzinom ist eine interdisziplinäre Herausforderung und sollte an speziellen Pankreaszentren erfolgen. Eine chirurgische Resektion kann in Einzelfällen und eingebettet in ein multimodales Konzept sinnvoll sein.

Abstract

Background

Most patients with pancreatic cancer suffer a relapse, which occurs either locally or systemically in the sense of liver and the lung metastases. Surgery for pancreatic cancer has become more radical due to the increased use of multimodal treatment concepts; however, the role of surgery in cases of recurrence remains controversial.

Objective

This review summarizes the surgical treatment options for isolated local recurrence and metachronous oligometastatic pancreatic cancer.

Material and methods

A selective literature search was carried out and the current evidence for surgical treatment is summarized.

Results

There are currently no randomized studies on surgery for metastatic pancreatic cancer. Currently available data, however, show that after surgery long-term survival of up to 32–47 months after metastasectomy can be achieved, especially in patients with local recurrence or isolated pulmonary metastases with low morbidity and mortality. Individualized treatment concepts including surgical resection after initial systemic therapy seem promising even for liver metastases. The greatest survival benefits are consistently shown for all localizations in patients with a long as possible disease-free interval after the first operation.

Conclusion

The treatment of isolated local recurrence or metachronous oligometastatic pancreatic cancer is an interdisciplinary challenge that should be performed in specialized pancreatic treatment centers only. Surgical resection embedded in a multimodal treatment concept can be meaningful in selected cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS (2007) National failure to operate on early stage pancreatic cancer. Ann Surg 246(2):173–180

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hartwig W, Hackert T, Hinz U, Gluth A, Bergmann F, Strobel O, Buchler MW, Werner J (2011) Pancreatic cancer surgery in the new millennium: better prediction of outcome. Ann Surg 254(2):311–319

    Article  PubMed  Google Scholar 

  3. Neoptolemos JP, Stocken DD, Bassi C, Ghaneh P, Cunningham D, Goldstein D, Padbury R, Moore MJ, Gallinger S, Mariette C, Wente MN, Izbicki JR, Friess H, Lerch MM, Dervenis C, Olah A, Butturini G, Doi R, Lind PA, Smith D, Valle JW, Palmer DH, Buckels JA, Thompson J, McKay CJ, Rawcliffe CL, Buchler MW (2010) Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA 304(10):1073–1081

    Article  CAS  PubMed  Google Scholar 

  4. Strobel O, Hank T, Hinz U, Bergmann F, Schneider L, Springfeld C, Jager D, Schirmacher P, Hackert T, Buchler MW (2017) Pancreatic cancer surgery: the new R‑status counts. Ann Surg 265(3):565–573

    Article  PubMed  Google Scholar 

  5. Conroy T, Hammel P, Hebbar M, Ben Abdelghani M, Wei AC, Raoul JL, Chone L, Francois E, Artru P, Biagi JJ, Lecomte T, Assenat E, Faroux R, Ychou M, Volet J, Sauvanet A, Breysacher G, Di Fiore F, Cripps C, Kavan P, Texereau P, Bouhier–Leporrier K, Khemissa-Akouz F, Legoux JL, Juzyna B, Gourgou S, O’Callaghan CJ, Jouffroy-Zeller C, Rat P, Malka D, Castan F, Bachet JB (2018) FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med 379(25):2395–2406

    Article  CAS  PubMed  Google Scholar 

  6. Griffin JF, Smalley SR, Jewell W, Paradelo JC, Reymond RD, Hassanein RE, Evans RG (1990) Patterns of failure after curative resection of pancreatic carcinoma. Cancer 66(1):56–61

    Article  CAS  PubMed  Google Scholar 

  7. Groot VP, Rezaee N, Wu W, Cameron JL, Fishman EK, Hruban RH, Weiss MJ, Zheng L, Wolfgang CL, He J (2018) Patterns, timing, and predictors of recurrence following pancreatectomy for pancreatic ductal adenocarcinoma. Ann Surg 267(5):936–945

    Article  PubMed  Google Scholar 

  8. Van den Broeck A, Sergeant G, Ectors N, Van Steenbergen W, Aerts R, Topal B (2009) Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma. Eur J Surg Oncol 35(6):600–604

    Article  CAS  PubMed  Google Scholar 

  9. Hishinuma S, Ogata Y, Tomikawa M, Ozawa I, Hirabayashi K, Igarashi S (2006) Patterns of recurrence after curative resection of pancreatic cancer, based on autopsy findings. J Gastrointest Surg 10(4):511–518

    Article  PubMed  Google Scholar 

  10. Kleeff J, Reiser C, Hinz U, Bachmann J, Debus J, Jaeger D, Friess H, Buchler MW (2007) Surgery for recurrent pancreatic ductal adenocarcinoma. Ann Surg 245(4):566–572

    Article  PubMed  PubMed Central  Google Scholar 

  11. Heye T, Zausig N, Klauss M, Singer R, Werner J, Richter GM, Kauczor HU, Grenacher L (2011) CT diagnosis of recurrence after pancreatic cancer: is there a pattern? World J Gastroenterol 17(9):1126–1134

    Article  PubMed  PubMed Central  Google Scholar 

  12. Yamada S, Kobayashi A, Nakamori S, Baba H, Yamamoto M, Yamaue H, Fujii T (2018) Resection for recurrent pancreatic cancer in the remnant pancreas after pancreatectomy is clinically promising: results of a project study for pancreatic surgery by the Japanese society of hepato-biliary-pancreatic surgery. Surgery 164(5):1049–1056

    Article  PubMed  Google Scholar 

  13. Groot VP, van Santvoort HC, Rombouts SJ, Hagendoorn J, Borel Rinkes IH, van Vulpen M, Herman JM, Wolfgang CL, Besselink MG, Molenaar IQ (2017) Systematic review on the treatment of isolated local recurrence of pancreatic cancer after surgery; re-resection, chemoradiotherapy and SBRT. HPB (Oxford) 19(2):83–92

    Article  Google Scholar 

  14. Krautz C, Nimptsch U, Weber GF, Mansky T, Grutzmann R (2018) Effect of hospital volume on in-hospital morbidity and mortality following pancreatic surgery in Germany. Ann Surg 267(3):411–417

    Article  PubMed  Google Scholar 

  15. Birkmeyer JD, Sun Y, Wong SL, Stukel TA (2007) Hospital volume and late survival after cancer surgery. Ann Surg 245(5):777–783

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gooiker GA, van der Geest LG, Wouters MW, Vonk M, Karsten TM, Tollenaar RA, Bonsing BA (2011) Quality improvement of pancreatic surgery by centralization in the western part of the Netherlands. Ann Surg Oncol 18(7):1821–1829

    Article  PubMed  PubMed Central  Google Scholar 

  17. Werner J, Combs SE, Springfeld C, Hartwig W, Hackert T, Buchler MW (2013) Advanced-stage pancreatic cancer: therapy options. Nat Rev Clin Oncol 10(6):323–333

    Article  CAS  PubMed  Google Scholar 

  18. Veereman G, Robays J, Verleye L, Leroy R, Rolfo C, Van Cutsem E, Bielen D, Ceelen W, Danse E, De Man M, Demetter P, Flamen P, Hendlisz A, Sinapi I, Vanbeckevoort D, Ysebaert D, Peeters M (2015) Pooled analysis of the surgical treatment for colorectal cancer liver metastases. Crit Rev Oncol Hematol 94(1):122–135

    Article  CAS  PubMed  Google Scholar 

  19. Hackert T, Niesen W, Hinz U, Tjaden C, Strobel O, Ulrich A, Michalski CW, Buchler MW (2017) Radical surgery of oligometastatic pancreatic cancer. Eur J Surg Oncol 43(2):358–363

    Article  CAS  PubMed  Google Scholar 

  20. Sakaguchi T, Valente R, Tanaka K, Satoi S, Del Chiaro M (2019) Surgical treatment of metastatic pancreatic ductal adenocarcinoma: a review of current literature. Pancreatology 19(5):672–680

    Article  PubMed  Google Scholar 

  21. Katz MH, Wang H, Fleming JB, Sun CC, Hwang RF, Wolff RA, Varadhachary G, Abbruzzese JL, Crane CH, Krishnan S, Vauthey JN, Abdalla EK, Lee JE, Pisters PW, Evans DB (2009) Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol 16(4):836–847

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ilmer M, Schiergens TS, Renz BW, Schneider C, Sargut M, Waligora R, Weniger M, Hartwig W, Ceyhan GO, Friess H, Werner J, D’Haese JG (2019) Oligometastatic pulmonary metastasis in pancreatic cancer patients: safety and outcome of resection. Surg Oncol 31:16–21

    Article  PubMed  Google Scholar 

  23. Arnaoutakis GJ, Rangachari D, Laheru DA, Iacobuzio-Donahue CA, Hruban RH, Herman JM, Edil BH, Pawlik TM, Schulick RD, Cameron JL, Meneshian A, Yang SC, Wolfgang CL (2011) Pulmonary resection for isolated pancreatic adenocarcinoma metastasis: an analysis of outcomes and survival. J Gastrointest Surg 15(9):1611–1617

    Article  PubMed  PubMed Central  Google Scholar 

  24. Lavu H, Nowcid LJ, Klinge MJ, Mahendraraj K, Grenda DR, Sauter PK, Rosato EL, Kennedy EP, Yeo CJ (2011) Reoperative completion pancreatectomy for suspected malignant disease of the pancreas. J Surg Res 170(1):89–95

    Article  PubMed  Google Scholar 

  25. Thomas RM, Truty MJ, Nogueras-Gonzalez GM, Fleming JB, Vauthey JN, Pisters PW, Lee JE, Rice DC, Hofstetter WL, Wolff RA, Varadhachary GR, Wang H, Katz MH (2012) Selective reoperation for locally recurrent or metastatic pancreatic ductal adenocarcinoma following primary pancreatic resection. J Gastrointest Surg 16(9):1696–1704

    Article  PubMed  Google Scholar 

  26. Strobel O, Hartwig W, Hackert T, Hinz U, Berens V, Grenacher L, Bergmann F, Debus J, Jager D, Buchler M, Werner J (2013) Re-resection for isolated local recurrence of pancreatic cancer is feasible, safe, and associated with encouraging survival. Ann Surg Oncol 20(3):964–972

    Article  PubMed  Google Scholar 

  27. Hashimoto D, Chikamoto A, Ohmuraya M, Sakata K, Miyake K, Kuroki H, Watanabe M, Beppu T, Hirota M, Baba H (2014) Pancreatic cancer in the remnant pancreas following primary pancreatic resection. Surg Today 44(7):1313–1320

    Article  PubMed  Google Scholar 

  28. Miyazaki M, Yoshitomi H, Shimizu H, Ohtsuka M, Yoshidome H, Furukawa K, Takayasiki T, Kuboki S, Okamura D, Suzuki D, Nakajima M (2014) Repeat pancreatectomy for pancreatic ductal cancer recurrence in the remnant pancreas after initial pancreatectomy: is it worthwhile? Surgery 155(1):58–66

    Article  PubMed  Google Scholar 

  29. Boone BA, Zeh HJ, Mock BK, Johnson PJ, Dvorchik I, Lee K, Moser AJ, Bartlett DL, Marsh JW (2014) Resection of isolated local and metastatic recurrence in periampullary adenocarcinoma. HPB (Oxford) 16(3):197–203

    Article  Google Scholar 

  30. Shima Y, Okabayashi T, Kozuki A, Sumiyoshi T, Tokumaru T, Saisaka Y, Date K, Iwata J (2015) Completion pancreatectomy for recurrent pancreatic cancer in the remnant pancreas: report of six cases and a review of the literature. Langenbecks Arch Surg 400(8):973–978

    Article  PubMed  Google Scholar 

  31. Suzuki S, Furukawa T, Oshima N, Izumo W, Shimizu K, Yamamoto M (2016) Original scientific reports: clinicopathological findings of remnant pancreatic cancers in survivors following curative resections of pancreatic cancers. World J Surg 40(4):974–981

    Article  PubMed  Google Scholar 

  32. Kim YI, Song KB, Lee YJ, Park KM, Hwang DW, Lee JH, Shin SH, Kwon JW, Ro JS, Kim SC (2019) Management of isolated recurrence after surgery for pancreatic adenocarcinoma. Br J Surg 106(7):898–909

    Article  CAS  PubMed  Google Scholar 

  33. Dunschede F, Will L, von Langsdorf C, Mohler M, Galle PR, Otto G, Vahl CF, Junginger T (2010) Treatment of metachronous and simultaneous liver metastases of pancreatic cancer. Eur Surg Res 44(3–4):209–213

    Article  CAS  PubMed  Google Scholar 

  34. Zanini N, Lombardi R, Masetti M, Giordano M, Landolfo G, Jovine E (2015) Surgery for isolated liver metastases from pancreatic cancer. Updates Surg 67(1):19–25

    Article  PubMed  Google Scholar 

  35. Liu Q, Zhang R, Michalski CW, Liu B, Liao Q, Kleeff J (2020) Surgery for synchronous and metachronous single-organ metastasis of pancreatic cancer: a SEER database analysis and systematic literature review. Sci Rep 10(1):4444

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Robinson LA, Tanvetyanon T, Springett G, Fontaine J, Toloza E, Hodul P, Pimiento JM, Malafa M (2016) Pulmonary metastasectomy for suspected pancreaticobiliary cancer. J Thorac Cardiovasc Surg 152(1):75–82

    Article  PubMed  Google Scholar 

  37. Decoster C, Gilabert M, Autret A, Turrini O, Oziel-Taieb S, Poizat F, Giovannini M, Viens P, Iovanna J, Raoul JL (2016) Heterogeneity of metastatic pancreatic adenocarcinoma: lung metastasis show better prognosis than liver metastasis‑a case control study. Oncotarget 7(29):45649–45655

    Article  PubMed  Google Scholar 

  38. Downs-Canner S, Zenati M, Boone BA, Varley PR, Steve J, Hogg ME, Zureikat A, Zeh HJ, Lee KK (2015) The indolent nature of pulmonary metastases from ductal adenocarcinoma of the pancreas. J Surg Oncol 112(1):80–85

    Article  PubMed  PubMed Central  Google Scholar 

  39. Nakajima M, Ueno T, Suzuki N, Matsui H, Shindo Y, Sakamoto K, Tokuhisa Y, Tokumitsu Y, Takeda S, Yoshino S, Hazama S, Nagano H (2017) Novel indications for surgical resection of metachronous lung metastases from pancreatic cancer after curative resection. J Clin Gastroenterol 51(5):e34–e38

    Article  PubMed  Google Scholar 

  40. Okui M, Yamamichi T, Asakawa A, Harada M, Horio H (2017) Resection for pancreatic cancer lung metastases. Korean J Thorac Cardiovasc Surg 50(5):326–328

    Article  PubMed  PubMed Central  Google Scholar 

  41. Yasukawa M, Kawaguchi T, Kawai N, Tojo T, Taniguchi S (2017) Surgical treatment for pulmonary metastasis of pancreatic ductal adenocarcinoma: study of 12 cases. Anticancer Res 37(10):5573–5576

    PubMed  Google Scholar 

  42. Groot VP, Blair AB, Gemenetzis G, Ding D, Burkhart RA, van Oosten AF, Molenaar IQ, Cameron JL, Weiss MJ, Yang SC, Wolfgang CL, He J (2019) Isolated pulmonary recurrence after resection of pancreatic cancer: the effect of patient factors and treatment modalities on survival. HPB (Oxford) 21(8):998–1008

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Allgemein, Viszeral- und Transplantationschirurgie, Klinikum der Universität München, Standort Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    J. G. D’Haese, B. W. Renz, M. Ilmer &  J. Werner

Authors
  1. J. G. D’Haese
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. W. Renz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Ilmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Werner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. G. D’Haese.

Ethics declarations

Interessenkonflikt

J. G. D’Haese, B. W. Renz, M. Ilmer und J. Werner 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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

D’Haese, J.G., Renz, B.W., Ilmer, M. et al. Chirurgie bei isoliertem Lokalrezidiv und metachroner Oligometastasierung beim Pankreaskarzinom. Chirurg 91, 628–635 (2020). https://doi.org/10.1007/s00104-020-01190-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-020-01190-y

Schlüsselwörter

Keywords

Search

Navigation