Operatives Management bei der Therapie des Pankreaskarzinoms

Zusammenfassung

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).

Pankreaskarzinom - chirurgische Therapie - Operationsverfahren - Morbidität - Mortalität

Pancreatic cancer - surgical therapy - operation methods - morbidity - mortality

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