Intraduktale Pankreasneoplasien: pro chirurgische Therapie – pro surveillance

Zusammenfassung

Intraduktale papillär-muzinöse Neoplasien (IPMN) gehören zu den häufigsten Formen zystischer Pankreastumoren. Präoperativ ist eine sichere Diagnosestellung schwierig und die Mehrzahl aller IPMN sind zum Operationszeitpunkt bereits maligne (Carcinoma in situ, invasives Karzinom). Eine kurative Therapie ist daher einzig durch eine frühe radikale 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 (so vor allem bei Seitenast-IPMN), sollten im Rahmen kontrollierter, randomisierter Studien beobachtet werden, um diagnostische Kriterien zu finden, die es ermöglichen, zwischen invasiven IPMN und nicht invasiven IPMN zu unterscheiden. Bis Ergebnisse solcher Studien vorhanden sind, sollte Patienten mit IPMN in der Regel eine chirurgische Behandlung empfohlen werden.

Abstract

Intraductal papillary mucinous neoplasms (IPMN) are the most common cystic tumours of the pancreas. The preoperative diagnosis of IPMN malignancy is difficult and the majority of IPMN are malignant upon diagnosis. Thus, only the early radical resection of the pancreas with regional lymph node dissection offers the patient a chance for cure. A discussion of the type “to resect or not to resect” should, furthermore, be held only within the walls of high-volume pancreatic centres and patients managed by the “watchful waiting” strategy (mainly branch-duct type IPMN) should all be recruited into large randomised controlled trials aimed to discover reliable diagnostic criteria to differentiate between invasive and non-invasive IPMN. Until then an aggressive surgical approach should be recommended as the standard treatment for all patients with IPMN.

Schlüsselwörter

intraduktale papillär-muzinöse Neoplasien - IPMN - chirurgische Therapie - Pankreaszentrum

Key words

intraductal papillary mucinous neoplasms - IPMN - surgical treatment - pancreatic centres

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