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Allgemein- und Viszeralchirurgie up2date 2019; 13(06): 511-530
DOI: 10.1055/a-1034-3032
Leber, Galle, Pankreas, Milz
Georg Thieme Verlag KG Stuttgart · New York

Pankreaskarzinom – Chirurgie im Wandel der multimodalen Therapiemöglichkeiten

Orlin Belyaev
,
Waldemar Uhl
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Publication History

Publication Date:
29 November 2019 (online)

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Diese zweiteilige Übersichtsarbeit fasst die evidenzbasierten aktuellen Standards in der Versorgung von Patienten mit Pankreaskarzinom zusammen: Im 1. Teil wurden die Pathologie, die Ätiologie sowie das diagnostische Vorgehen dargestellt und die epidemiologischen Fakten zusammengefasst [1]. Dieser 2. Teil widmet sich den therapeutischen Prinzipien und Möglichkeiten.
Kernaussagen

  • Die Prognose des duktalen Adenokarzinom des Pankreas („pancreatic ductal adenocarcinoma“, PDAC) ist mit einer 5-Jahres-Überlebensrate von unter 10% die schlechteste unter allen Krebsarten.

  • Der einzig kurative Einsatz bleibt die radikale chirurgische Resektion als Duodenohemipankreatektomie, Pankreaslinksresektion oder totale Duodenopankreatektomie mit entsprechender Lymphknotendissektion.

  • Der Einsatz der chemotherapeutischen Regimes Folfirinox und Gemcitabin/nab-Paclitaxel in multimodalen Konzepten hat die Überlebenszeiten im adjuvanten und palliativen Setting deutlich verlängert, aber auch die Resektionsraten und Überlebenschancen bei lokal fortgeschrittenen Pankreaskarzinomen wesentlich erhöht.

  • Eine spürbare Verbesserung der immer noch schlechten Langzeitprognose kann nur durch Weiterentwicklung der frühzeitigen Diagnostik und Etablierung individualisierter Therapiestrategien erreicht werden – auf jeden Fall wird die Therapie des exokrinen Pankreaskarzinoms multimodal.

Schlüsselwörter

Onkologie - Bauchspeicheldrüsenkrebs - Malignom - Tumorerkrankung - Tumorchirurgie - Chemotherapie
 

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