Download PDF
Allgemein- und Viszeralchirurgie up2date 2017; 11(04): 417-438
DOI: 10.1055/s-0043-105843
Leber, Galle, Pankreas, Milz
Georg Thieme Verlag KG Stuttgart · New York

Diagnostik und Therapie von zystischen Pankreastumoren

Orlin Belyaev
,
Waldemar Uhl
Further Information

Publication History

Publication Date:
23 August 2017 (online)

Also available at
    Permissions and Reprints All articles of this category

Die zystischen Pankreastumoren gehören zu den seltenen Tumoren der Bauchspeicheldrüse, umfassen aber gleichzeitig ein breites Spektrum von Entitäten mit spezifischen histomorphologischen Eigenschaften und unterschiedlicher Prognose. Die 5 Entitäten: intraduktale papillär-muzinöse Neoplasie, muzinöse zystische Neoplasie, seröse zystische Neoplasie, solid-pseudopapilläre Neoplasie (oder Frantz-Tumor) und Pankreaspseudozysten machen 95% dieser zystischen Pankreasläsionen aus.
Kernaussagen

  • Zystische Pankreastumoren werden immer häufiger, oft zufällig diagnostiziert; die intraduktale papillär-muzinöse Neoplasie (IPMN) ist der wichtigste Vertreter dieser Gruppe.

  • Präoperativ ist eine sichere Diagnosestellung schwierig, und ein signifikanter Anteil aller zystischen Neoplasien sind zum Operationszeitpunkt bereits maligne.

  • Eine sichere kurative Therapie ist daher einzig durch eine rechtzeitige und onkologische Pankreasresektion mit regionaler Lymphknotendissektion möglich.

  • Die Entscheidung bezüglich Resektion oder konservativer Verlaufsbeobachtung sollte in interdisziplinären Pankreaszentren mit hohem Patientenaufkommen getroffen werden.

  • Patienten, bei denen ein konservativer Behandlungsansatz gewählt wird, sollten im Rahmen kontrollierter, randomisierter Studien beobachtet werden, um diagnostische Kriterien zu finden, die eine frühzeitige Differenzierung zwischen benignen und malignen zystischen Pankreastumoren ermöglichen.

Schlüsselwörter

Onkologie - Pankreaskarzinom - Viszeralchirurgie - Bauchspeicheldrüse
 

  • Literatur

  • 1 Stark A, Donahue TR, Reber HA. et al. Pancreatic cystic disease: a review. JAMA 2016; 315: 1882-1893
    CrossrefPubMedGoogle Scholar
  • 2 Karoumpalis I, Christodoulou DK. Cystic lesions of the pancreas. Ann Gastroenterol 2016; 29: 155-161
    PubMedGoogle Scholar
  • 3 Chang YR, Park JK, Jang JY. et al. Incidental pancreatic cystic neoplasms in an asymptomatic healthy population of 21,745 individuals. Medicine (Baltimore) 2016; 95: e5535
    CrossrefPubMedGoogle Scholar
  • 4 Mönnings P, Belyaev O, Uhl W. et al. Criteria for determining malignancy in pancreatic intraductal papillary mucinous neoplasm based on computed tomography. Digestion 2016; 94: 230-239
    CrossrefPubMedGoogle Scholar
  • 5 Distler M, Welsch T, Aust D. et al. Intraduktale papillär-muzinöse Neoplasien (IPMN) des Pankreas – Standards und neue Aspekte. Zentralbl Chir 2014; 139: 308-317
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Moris M, Wallace MB. Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations. Rev Esp Enferm Dig 2017; 109: 358-367
    PubMedGoogle Scholar
  • 7 Tanaka M. Current best practice and controversies in the follow up of patients with asymptomatic branch duct IPMN of the pancreas. HPB (Oxford) 2016; 18: 709-711
    CrossrefPubMedGoogle Scholar
  • 8 Walsh RM. Current controversies in pancreatic cystic neoplasms. Am J Surg 2017; 213: 443-447
    CrossrefPubMedGoogle Scholar
  • 9 Reid MD, Lewis MM, Willingham FF. et al. The evolving role of pathology in new developments, classification, terminology, and diagnosis of pancreatobiliary neoplasms. Arch Pathol Lab Med 2016; DOI: 10.5858/arpa.2016-0262-SA.
    CrossrefPubMedGoogle Scholar
  • 10 Tanaka M. International consensus on the management of intraductal papillary mucinous neoplasm of the pancreas. Ann Transl Med 2015; 3: 286
    PubMedGoogle Scholar
  • 11 Belyaev O, Seelig MH, Muller CA. et al. Intraductal papillary mucinous neoplasms of the pancreas. J Clin Gastroenterol 2008; 42: 284-294
    PubMedGoogle Scholar
  • 12 Basturk O, Hong S, Wood L. et al. A revised classification system and recommendations from the Baltimore consensus meeting for neoplastic precursor lesions in the pancreas. Am J Surg Pathol 2015; 39: 1730-1741
    CrossrefPubMedGoogle Scholar
  • 13 Wilson GC, Maithel SK, Bentrem D. et al. Are the current guidelines for the surgical management of intraductal papillary mucinous neoplasms of the pancreas adequate? A multi-institutional study. J Am Coll Surg 2017; DOI: 10.1016/j.jamcollsurg.2016.12.031.
    CrossrefPubMedGoogle Scholar
  • 14 Robles EP, Maire F, Cros J. et al. Accuracy of 2012 International Consensus Guidelines for the prediction of malignancy of branch-duct intraductal papillary mucinous neoplasms of the pancreas. United European Gastroenterol J 2016; 4: 580-586
    CrossrefPubMedGoogle Scholar
  • 15 Hackert T, Fritz S, Klauss M. et al. Main-duct intraductal papillary mucinous neoplasm: high cancer risk in duct diameter of 5 to 9 mm. Ann Surg 2015; 262: 875-880
    CrossrefPubMedGoogle Scholar
  • 16 Jang JY, Park T, Lee S. et al. Proposed nomogram predicting the individual risk of malignancy in the patients with branch duct type intraductal papillary mucinous neoplasms of the pancreas. Ann Surg 2016; DOI: 10.1097/SLA.0000000000001985.
    CrossrefPubMedGoogle Scholar
  • 17 Crippa S, Piccioli A, Salandini MC. et al. Treatment of branch-duct intraductal papillary mucinous neoplasms of the pancreas: state of the art. Updates Surg 2016; 68: 265-271
    CrossrefPubMedGoogle Scholar
  • 18 Hackert T, Fritz S, Büchler MW. Main- and branch-duct intraductal papillary mucinous neoplasms: extent of surgical resection. Viszeralmedizin 2015; 31: 38-42
    CrossrefPubMedGoogle Scholar
  • 19 Hsiao CY, Yang CY, Wu JM. et al. Utility of the 2006 Sendai and 2012 Fukuoka guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas: A single-center experience with 138 surgically treated patients. Medicine (Baltimore) 2016; 95: e4922
    CrossrefPubMedGoogle Scholar
  • 20 Seo N, Byun JH, Kim JH. et al. Validation of the 2012 International consensus guidelines using computed tomography and magnetic resonace imaging: branch duct and main duct intraductal papillary mucinous neoplasms of the pancreas. Ann Surg 2016; 263: 557-564
    CrossrefPubMedGoogle Scholar
  • 21 Cao S, Gao X, Zhao Y. Serum carbohydrate antigen 19-9 in differential diagnosis of benign and malignant pancreatic cystic neoplasms: a meta-analysis. PLoS One 2016; 11: e0166406
    CrossrefPubMedGoogle Scholar
  • 22 Ngyen AH, Toste PA, Farrell JJ. et al. Current recommendations for surveillance and surgery of intraductal papillary mucinous neoplasms may overlook some patients with cancer. J Gastrointest Surg 2015; 19: 258-265
    CrossrefPubMedGoogle Scholar
  • 23 Crippa S, Bassi C, Salvia R. et al. Low progression of intraductal papillary mucinous neoplasms with worrisome features and high-risk stigmata undergoing non-operative management: a mid-term follow-up analysis. Gut 2016; DOI: 10.1136/gutjnl-2015-310162.
    CrossrefPubMedGoogle Scholar
  • 24 Uhl W, Belyaev O, Herzog T. et al. Intraduktale Pankreasneoplasien: pro chirurgische Therapie – pro surveillance. Z Gastroenterol 2008; 46: 1290-1297
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Del Chiaro M, Ateeb Z, Hansson MR. et al. Survival analysis and risk for progression of intraductal papillary mucinous neoplasia of the pancreas (IPMN) under surveillance: a single-institution experience. Ann Surg Oncol 2017; 24: 1120-1126
    CrossrefPubMedGoogle Scholar
  • 26 Nilsson LN, Keane MG, Shamali A. et al. Nature and management of pancreatic mucinous cystic neoplasm (MCN): a systematic review of the literature. Pancreatology 2016; 16: 1028-1036
    CrossrefPubMedGoogle Scholar
  • 27 Griffin JF, Page AJ, Samaha GJ. et al. Patients with a resected pancreatic mucinous cystic neoplasm have a better prognosis than patients with intraductal papillary mucinous neoplasm: a large single institution series. Pancreatology 2017; 17: 490-496
    CrossrefPubMedGoogle Scholar
  • 28 Gerry JM, Poultsides GA. Surgical management of pancreatic cysts: a shifting paradigm toward selective resection. Dig Dis Sci 2017; 62: 1816-1826
    CrossrefPubMedGoogle Scholar
  • 29 Pak LM, DʼAngelica MI, DeMatteo RP. et al. Natural history of patients followed radiographically with mucinous cysts of the pancreas. J Gastrointest Surg 2017; DOI: 10.1007/s11605-016-3338-1.
    CrossrefPubMedGoogle Scholar
  • 30 Kölby D, Andersson R, Sasor A. et al. Multifocal intraductal tubulopapullary neoplasm of the pancreas with total pancreatectomy: report of a case and review of the literature. Int J Clin Exp Pathol 2015; 8: 9672-9680
    PubMedGoogle Scholar
  • 31 Jais B, Rebours V, Malleo G. et al. Serous cystic neoplasm of the pancreas: a multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas). Gut 2016; 65: 305-312
    CrossrefPubMedGoogle Scholar
  • 32 Huh J, Byun SM, Kim KW. et al. Malignant pancreatic serous cystic neoplasms: systemtic review with a new case. BMC Gastroenterology 2016; 16: 97
    CrossrefPubMedGoogle Scholar
  • 33 Law JK, Ahmed A, Singh VK. et al. A systematic review of solid-pseuodpapillary neoplasms: are these rare lesions?. Pancreas 2014; 43: 331-337
    CrossrefPubMedGoogle Scholar
  • 34 Munding J, Sunitsch S, Belyaev O. et al. Solid pseudopapillary tumors of the pancreas: a case series, comparison of histopathological and clinical data. Z Gastroenterol 2011; 49: 1417-1422
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Correa-Gallego C, Ferrone CR, Thayer SP. et al. Incidental pancreatic cysts: do we really know what are we watching?. Pancreatology 2010; 10: 144-150
    CrossrefPubMedGoogle Scholar
  • 36 Kimura K, Amano R, Ymazoe S. et al. The clinical indications for limited surgery of intraductal papillary mucinous neoplasms of the pancreas. World J Surg 2017; 41: 1358-1365
    CrossrefPubMedGoogle Scholar
  • 37 Kaiser J, Fritz S, Klauss M. et al. Enucleation: a treatment alternative for branch duct intraductal papillary mucinous neoplasms. Surgery 2017; 161: 602-610
    CrossrefPubMedGoogle Scholar
  • 38 Janot MS, Belyaev O, Kersting S. et al. Indications and early outcomes for total pancreatectomy at a high-volume pancreas center. HPB Surg 2010; 2010 DOI: 10.1155/2010/686702. (PMID: pii:686702)
    CrossrefPubMedGoogle Scholar
  • 39 Griffin JF, Poruk KE, Wolfgang CL. Is it time to expand the role of total pancreatectomy for IPMN?. Dig Surg 2016; 33: 335-342
    CrossrefPubMedGoogle Scholar
  • 40 McMillan MT, Lewis RS, Drebin JA. et al. The efficacy of adjuvant therapy for pancreatic invasive intraductal papillary mucinous neoplasm (IPMN). Cancer 2016; 122: 521-533
    CrossrefPubMedGoogle Scholar
  • 41 Nakagawa T, Masuda A, Toyama H. et al. Smoking status and the incidence of pancreatic cancer concomitant with intraductal papillary mucinous neoplasm. Pancreas 2017; DOI: 10.1097/MPA.0000000000000761.
    CrossrefPubMedGoogle Scholar
  • 42 Gementzis G, Bagante F, Griffin JF. et al. Neutrophil-to-lymphocyte ratio is a predictive marker for invasive malignancy in Intraductal Papillary Mucinous Neoplasms of the Pancreas. Ann Surg 2016; DOI: 10.1097/SLA.0000000000001988.
    CrossrefPubMedGoogle Scholar
  • 43 Vila-Navarro E, Vila-Casadesús M, Moreira L. et al. MicroRNAs for Detection of Pancreatic Neoplasia: Biomarker Discovery by Next-generation Sequencing and Validation in 2 Independent Cohorts. Ann Surg 2017; 265: 1226-1234
    CrossrefPubMedGoogle Scholar
  • 44 Berger AW, Schwerdel D, Costa IG. et al. Detection of hot-spot mutations in circulating cell-free DNA from patients with intraductal papillary mucinous neoplasms of the pancreas. Gastroenterology 2016; 151: 267-270
    CrossrefPubMedGoogle Scholar