Das Pankreaskarzinom ist eine der 10 häufigsten Todesursachen bei
Krebsleiden in der westlichen Welt. Aufgrund seiner geringen Ansprechrate bei
Bestrahlung und/oder Chemotherapie ist die radikale Operation die einzige
kurative Therapieoption. Jedoch weisen ca. 80 % der Patienten
bereits bei Diagnosestellung aufgrund lokaler Tumorinfiltration oder
Fernmetastasen ein nicht mehr kurativ resezierbares Tumorstadium auf. Dies ist
eine der Ursachen für die schlechte 5-Jahres-Überlebensrate von
3-24 % bei Pankreaskarzinompatienten. Bei gegebener
Resektabilität gilt der klassische Whipple bei Pankreaskopftumoren immer
noch als die Operationsmethode der Wahl. Studien zeigen jedoch zunehmend die
Bedeutung der Pylorus-erhaltenden Whipple Operation, so dass diese OP-Methode
bereits als gleichwertiges Standardverfahren angesehen werden kann. Die vor
allem von japanischen Chirurgen propagierten erweiterten- bzw. regionalen
Pankreasresektionen scheinen vom Konzept her in eine zukunftweisende Richtung
zu deuten, allerdings konnte im Vergleich zum klassischen- oder
Pylorus-erhaltenden Whipple bisher kein Vorteil im Hinblick auf das
Langzeitüberleben bewiesen werden. Die europäische Multizenterstudie
ESPAC-1 zeigt erstmalig in einem prospektiven, kontrollierten und
randomisierten Studienansatz mit ausreichender Patientenzahl, dass Patienten
nach einer Pankreaskarzinomresektion von einer adjuvanten Chemotherapie (5-FU
und Folsäure), jedoch nicht von einer Radiochemotherapie (40 Gy und
5-FU) im Hinblick auf eine Verlängerung des medianen Überlebens
(19,7 Monate vs. 14,0 Monate) profitieren.
Abstract
The carcinoma of the pancreas is one of the 10 leading causes of death in
the Western countries. Because of the resistance of pancreatic cancer against
radiation and/or chemotherapy surgery is still the only possibility for cure.
However, about 80 % of patients with the diagnosis of pancreatic
cancer are no more suitable for curative resection at the time of diagnosis
because of local tumor infiltration or the presence of distant metastases. This
is one reason for the unsatisfactory situation in terms of 5-year-survival rate
of 3 to 24 %. In resectable tumors of the pancreas head the
standard Whipple dominates still as the surgical method of choice. However, the
pylorus preserving Whipple has been established as a surgical alternative to
the classical Whipple. Other surgical procedures like extended or regional
pancreatic resections, predominantly done by Japanese surgeons seem to fit the
concept of radical resection. But compared to the classical Whipple or the
pylorus preserving Whipple resection there is still no clear advantage in terms
of long term survival. The prospective European multicenter study ESPAC-1
firstly demonstrated a survival advantage for adjuvant chemotherapy (5-FU and
folic acid) but no gain for radiochemotherapy in the treatment of patients with
R0 or R1 resected pancreatic cancer in terms of prolongation of mean survival
(19.7 months vs. 14.0 months).
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