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Allgemein- und Viszeralchirurgie up2date 2024; 18(04): 305-325
DOI: 10.1055/a-2318-7897
Leber, Galle, Pankreas, Milz

Pankreaskarzinom

Indikation zur arteriovenösen und multiviszeralen Resektion
Nicolas Mibelli
,
Jürgen Weitz
,
Sebastian Hempel
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Das Pankreaskarzinom stellt Chirurgen vor große Herausforderungen. Neue Therapiekonzepte und fortschrittliche Operationstechniken eröffnen jedoch Möglichkeiten für Patienten mit fortgeschrittenen und initial inoperablen Tumoren. Multiviszerale Resektionen und arterio-venöse Gefäßrekonstruktionen in spezialisierten Zentren können im Vergleich zur Palliation die Überlebenschancen deutlich verbessern. Der Artikel beleuchtet aktuelle Kriterien der Resektabilität, die Bedeutung des „Mesopankreas“, die arterio-venösen Rekonstruktionsmöglichkeiten und die Indikationen für komplexe chirurgische Eingriffe.
Kernaussagen

  • Bei Borderline-resektablen oder lokal fortgeschrittenen Pankreaskarzinomen mit Infiltration von Nachbarorganen und von arteriovenösen Strukturen besteht nach erfolgter neoadjuvanter Chemotherapie die Indikation zur En-bloc-Resektion, sofern dadurch eine R0-Resektion erzielt werden kann.

  • Mehrere Resektions- und Rekonstruktionsverfahren stehen abhängig von der Tumorlokalisation und -infiltration zur Verfügung.

  • Arteriovenöse Resektionen und/oder Multiviszeralresektion erlauben eine Verbesserung der Überlebensrate im Vergleich zur alleinigen palliativen Systemtherapie, ohne dabei die postoperative Letalität im Vergleich zu konventionellen Pankreasresektionen relevant zu erhöhen, wenngleich die Morbidität und der Klinikaufenthalt mit steigendem Resektionsausmaß zunehmen.

  • Arteriovenöse Resektionen und/oder Multiviszeralresektionen beim Pankreaskarzinom sollten daher für gut selektionierte Patienten angeboten werden.

  • Weitere prospektiv randomisierte Daten sind jedoch für eine bessere Auswahl der Patienten und Indikationsstellung nötig.

Schlüsselwörter

Pankreaskarzinom - Rekonstruktionsverfahren - multiviszerale Resektion - arterielle Resektion - venöse Resektion


Publication History

Article published online:
05 September 2024

© 2024. Thieme. All rights reserved.

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