Skip to main content
SpringerLink
Log in

Indikation zur Resektion beim Pankreaskarzinom – Wann ist eine Resektion vorteilhaft für den Patienten?

  • Chapter
  • First Online:
Erkrankungen des Pankreas

Zusammenfassung

Die chirurgische Therapie des Pankreaskarzinoms muss die komplette Tumorentfernung zum Ziel haben. Dies kann bei lokal begrenzten Tumoren durch die Standardresektionen (partielle Pankreatikoduodenektomie, distale Pankreatektomie, totale Pankreatikoduodenektomie) mit entsprechender Lymphadenektomie erfolgen. Sind die venösen mesenterico-portalen Gefäßstrukturen oder Nachbarorgane per continuitatem betroffen, ist eine kurative Resektion ebenfalls meist mit etwas erhöhter Morbidität, aber gleichwertigem onkologischem Outcome möglich. Eine Infiltration arterieller Gefäße (T4-Situation) und das Vorliegen von Metastasen stellen grundsätzliche Kontraindikationen für eine Resektion dar, da das onkologische Outcome keinen eindeutigen Vorteil für die Patienten zeigt. Jede chirurgische Therapie beim Pankreaskarzinom muss in ein interdisziplinäres onkologisches Konzept eingebunden sein, wobei die adjuvante Chemotherapie hier den größten Stellenwert hat.

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

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

Literatur

  • Adler G, Seufferlein T, Bischoff SC et al (2007) S3-Guidelines „Exocrine pancreatic cancer“ 2007. Z Gastroenterol 45: 487–523

    Article  PubMed  CAS  Google Scholar 

  • Amin S, Lucas AL, Frucht H (2013) Evidence for treatment and survival disparities by age in pancreatic adenocarcinoma: a population-based analysis. Pancreas 42(2): 249–253

    Article  PubMed  Google Scholar 

  • Bockhorn M, Burdelski C, Bogoevski D (2011) Arterial en bloc resection for pancreatic carcinoma. Br J Surg 98(1): 86–92

    Article  PubMed  CAS  Google Scholar 

  • Diener MK, Fitzmaurice C, Schwarzer G, Seiler CM, Antes G, Knaebel HP, Büchler MW (2011) Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database Syst Rev 5: CD006053

    Google Scholar 

  • Diener MK, Seiler CM, Rossion I et al (2011) Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet 377(9776): 1514–1522

    Article  PubMed  Google Scholar 

  • Esposito I, Kleeff J, Bergmann F, Reiser C, Herpel E, Friess H, Schirmacher P, Büchler MW (2008) Most pancreatic cancer resections are R1 resections. Ann Surg Oncol 15(6): 1651–1660

    Article  PubMed  Google Scholar 

  • Grenacher L, Klauss M (2009) Computed tomography of pancreatic tumors. Radiologe 49(2): 107–123

    Article  PubMed  CAS  Google Scholar 

  • Gudjonsson B (2009) Pancreatic cancer: survival, errors and evidence. Eur J Gastroenterol Hepatol 21(12): 1379–1382

    Article  PubMed  Google Scholar 

  • Hartwig W, Hackert T, Hinz U et al (2009) Multivisceral resection for pancreatic malignancies: risk-analysis and long-term outcome. Ann Surg 250(1): 81–87

    Article  PubMed  Google Scholar 

  • 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 

  • Kawai M, Tani M, Hirono S, Miyazawa M, Shimizu A, Uchiyama K, Yamaue H (2011) Pylorus ring resection reduces delayed gastric emptying in patients undergoing pancreatoduodenectomy: a prospective, randomized, controlled trial of pylorus-resecting versus pylorus-preserving pancreatoduodenectomy. Ann Surg 253(3): 495–501

    Article  PubMed  Google Scholar 

  • Klempnauer J, Ridder GJ, Piso P, Pichlmayr R (1996) Is liver resection in metastases of exocrine pancreatic carcinoma justified? Chirurg 67(4): 366–370

    PubMed  CAS  Google Scholar 

  • Köninger J, Wente MN, Müller-Stich BP, di Mola FF, Gutt CN, Hinz U, Müller MW, Friess H, Büchler MW (2008) R2 resection in pancreatic cancer – does it make sense? Langenbecks Arch Surg 393(6): 929–934

    Article  PubMed  Google Scholar 

  • Makary MA, Winter JM, Cameron JL, Campbell KA, Chang D, Cunningham SC, Riall TS, Yeo CJ (2006) Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg 10(3): 347–356

    Article  PubMed  Google Scholar 

  • Michalski CW, Kleeff J, Wente MN, Diener MK, Büchler MW, Friess H (2007) Systematic review and meta-analysis of standard and extended lymphadenectomy in pancreaticoduodenectomy for pancreatic cancer. Br J Surg 94(3): 265–273

    Article  PubMed  CAS  Google Scholar 

  • Mitchem JB, Hamilton N, Gao F, Hawkins WG, Linehan DC, Strasberg SM (2012) Long-term results of resection of adenocarcinoma of the body and tail of the pancreas using radical antegrade modular pancreatosplenectomy procedure. J Am Coll Surg 214(1): 46–52

    Article  PubMed  Google Scholar 

  • Mollberg N, Rahbari NN, Koch M et al (2011) Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg 254(6): 882–893

    Article  PubMed  Google Scholar 

  • Nentwich MF, Bockhorn M, König A, Izbicki JR, Cataldegirmen G (2012) Surgery for advanced and metastatic pancreatic cancer – current state and trends. Anticancer Res 32(5): 1999–2002

    PubMed  Google Scholar 

  • 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(12): 1200–1210

    Article  PubMed  CAS  Google Scholar 

  • Pedrazzoli S, DiCarlo V, Dionigi R, Mosca F, Pederzoli P, Pasquali C, Klöppel G, Dhaene K, Michelassi F (1998) Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg 228(4): 508–517

    Article  PubMed  CAS  Google Scholar 

  • Poultsides GA, Reddy S, Cameron JL, Hruban RH, Pawlik TM, Ahuja N, Jain A, Edil BH, Iacobuzio-Donahue CA, Schulick RD, Wolfgang CL (2010) Histopathologic basis for the favorable survival after resection of intraductal papillary mucinous neoplasm-associated invasive adenocarcinoma of the pancreas. Ann Surg 251(3): 470–476

    Article  PubMed  Google Scholar 

  • Rau BM, Moritz K, Schuschan S, Alsfasser G, Prall F, Klar E (2012) R1 resection in pancreatic cancer has significant impact on long-term outcome in standardized pathology modified for routine use. Surgery 152(3 Suppl 1): S103–111

    Article  PubMed  Google Scholar 

  • Schmidt J, Abel U, Debus J, Harig S, Hoffmann K, Herrmann T, Bartsch D, Klein J, Mansmann U, Jäger D, Capussotti L, Kunz R, Büchler MW (2012) Open-label, multicenter, randomized phase III trial of adjuvant chemoradiation plus interferon alfa-2b versus fluorouracil and folinic acid for patients with resected pancreatic adenocarcinoma. J Clin Oncol 30(33): 4077–4083

    Article  PubMed  CAS  Google Scholar 

  • Shrikhande SV, Kleeff J, Reiser C, Weitz J, Hinz U, Esposito I, Schmidt J, Friess H, Büchler MW (2007) Pancreatic resection for M1 pancreatic ductal adenocarcinoma. Ann Surg Oncol 14(1): 118–127. Epub 2006 Oct 25

    Google Scholar 

  • Simianu VV, Zyromski NJ, Nakeeb A, Lillemoe KD (2010) Pancreatic cancer: progress made. Acta Oncol 49(4): 407–417

    Article  PubMed  Google Scholar 

  • Siriwardana HP, Siriwardena AK (2006) Systematic review of outcome of synchronous portal-superior mesenteric vein resection during pancreatectomy for cancer. Br J Surg 93(6): 662–673

    Article  PubMed  CAS  Google Scholar 

  • Song KB, Kim SC, Park JB, Kim YH, Jung YS, Kim MH, Lee SK, Seo DW, Lee SS, Park do H, Han DJ (2011) Single-center experience of laparoscopic left pancreatic resection in 359 consecutive patients: changing the surgical paradigm of left pancreatic resection. Surg Endosc 25(10): 3364–3372

    Article  PubMed  Google Scholar 

  • Strobel O, Hartwig W, Hackert T, Hinz U, Berens V, Grenacher L, Bergmann F, Debus J, Jäger D, Büchler 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 

  • Verbeke CS, Leitch D, Menon KV, McMahon MJ, Guillou PJ, Anthoney A (2006) Redefining the R1 resection in pancreatic cancer. Br J Surg 93(10): 1232–1237

    Article  PubMed  CAS  Google Scholar 

  • Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Büchler MW (2004) Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg 91(5): 586–594

    Article  PubMed  CAS  Google Scholar 

  • Welsch T, Borm M, Degrate L, Hinz U, Büchler MW, Wente MN (2010) Evaluation of the International Study Group of Pancreatic Surgery definition of delayed gastric emptying after pancreatoduodenectomy in a high-volume centre. Br J Surg 97(7): 1043–1050

    Article  PubMed  CAS  Google Scholar 

  • Yeo CJ, Cameron JL, Sohn TA, Coleman J, Sauter PK, Hruban RH, Pitt HA, Lillemoe KD (1999) Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann Surg 229(5): 613–622

    Article  PubMed  CAS  Google Scholar 

  • Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, Hruban RH, Ord SE, Sauter PK, Coleman J, Zahurak ML, Grochow LB, Abrams RA (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226(3): 248–257

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    Thilo Hackert

  2. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universität Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    Werner Hartwig

Authors
  1. Thilo Hackert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Werner Hartwig
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thilo Hackert .

Editor information

Editors and Affiliations

  1. Abt. Allgemeine- und Visceralchirurgie, Universitätsklinikum Ulm, Germany

    Hans G. Beger

  2. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Germany

    Markus W. Büchler

  3. Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Halle, Sachsen-Anhalt, Germany

    Henning Dralle

  4. Klinik und Poliklinik für Innere Medizin, Universitätsmedizin Greifswald, Germany

    Markus M. Lerch

  5. und Hepatologie (KGHI), Universitätsklinikum Magdeburg, Germany

    Peter Malfertheiner

  6. FB Gastroenterologie und Hepatologie, Universitätsklinikum Leipzig, Sachsen, Germany

    Joachim Mössner

  7. ehemals Klinikum der Stadt Ludwigshafen gGmbH, Rheinland-Pfalz, Germany

    Jürgen F. Riemann

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Hackert, T., Hartwig, W. (2013). Indikation zur Resektion beim Pankreaskarzinom – Wann ist eine Resektion vorteilhaft für den Patienten?. In: Beger, H., et al. Erkrankungen des Pankreas. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37964-2_68

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-37964-2_68

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-37963-5

  • Online ISBN: 978-3-642-37964-2

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics

Search

Navigation