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Palliative interventionelle und chirurgische Therapie des Pankreaskarzinoms

Palliative interventionelle Therapie

Palliative interventional and surgical approaches to pancreatic malignancies

Palliative interventional approaches

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Der größte Teil der Pankreaskarzinome ist bei Diagnosestellung aufgrund der lokal fortgeschrittenen Erkrankung und/oder wegen Fernmetastasen inoperabel. Die meisten Pankreaskarzinome sitzen im Pankreaskopf. Das Hauptsymptom ist die extrahepatische Cholestase. Die entscheidende therapeutische Maßnahme ist die Herstellung der Gallengangsdränage entweder in das Duodenum endoskopisch oder perkutan transhepatisch, perkutan nach außen oder durch eine biliodigestive Anastomose. In der Mehrzahl der Fälle erfolgt die Platzierung eines Gallengangsstents über die ERC, nur in Ausnahmefällen ist eine PTCD erforderlich. Plastikstents okkludieren schneller als Metallstents und müssen etwa alle 3 Monate gewechselt werden. Liegt eine Duodenalobstruktion mit einer Stenosesymptomatik vor, ist ein operativer Bypass in Form einer Gastrojejunostomie ggf. mit biliodigestiver Anastomose indiziert. In einzelnen Fällen kann die Tumorstenose durch Einlage eines Duodenalstents überbrückt werden. Ziel dieser Maßnahmen ist die Gewährleistung einer möglichst hohen Lebensqualität für den Patienten. Ein Abwägen von endoskopischer und chirurgischer Palliation muss für den Patienten individuell entschieden werden.

Abstract

The majority of patients with pancreatic cancer are found to be unresectable due to infiltrative growth of the tumor into the celiac axis and the superior mesenteric vessels and/or due to distal metastases. Pancreatic cancer arises predominantly in the head of the pancreas. The patients come to medical attention when they develop jaundice secondary to obstruction of the distal common bile duct. Biliary decompression with stenting can be achieved by either endoscopic methods (ERC) or percutaneous transhepatic cholangiodrainage (PTCD) into the duodenum or outside. Plastic stents tend to occlude faster than metal stents and have to be exchanged after 3 months. Mechanical obstruction of the duodenum with nausea and vomiting requires gastrojejunostomy. In individual cases duodenal stents are used to bypass duodenal obstruction. The aim of these procedures is to guarantee quality of life for the patient. Endoscopic versus surgical palliation has to be balanced for each patient individually.

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Authors and Affiliations

  1. II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München

    R. M. Schmid, H. Weidenbach, B. Neu & P. Born

  2. Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Dresden

    F. Dobrowolski & H.-D. Saeger

  3. II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität, Ismaninger Straße 22, 81675, München

    R. M. Schmid

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  1. R. M. Schmid
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  2. H. Weidenbach
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  3. B. Neu
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  4. P. Born
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  5. F. Dobrowolski
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  6. H.-D. Saeger
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Correspondence to R. M. Schmid.

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Schmid, R.M., Weidenbach, H., Neu, B. et al. Palliative interventionelle und chirurgische Therapie des Pankreaskarzinoms. Onkologe 10, 1320–1327 (2004). https://doi.org/10.1007/s00761-004-0798-9

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  • DOI: https://doi.org/10.1007/s00761-004-0798-9

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