Zusammenfassung
Der häufigste maligne Tumor des Pankreas ist das duktale Adenokarzinom. Eine komplette Tumorresektion ist nach wie vor der einzige potenziell kurative Therapieansatz. Die häufigste Tumorlokalisation ist der Pankreaskopf. Somit stellt die Pankreatoduodenektomie (Whipple/PPPD) das onkologische Standardoperationsverfahren dar. Durch Konzentration der Pankreasresektionen auf spezialisierte Zentren konnte die perioperative Morbidität und Mortalität in den letzten Jahren gesenkt werden. Nichtsdestotrotz bleibt gerade die Pankreaskopfresektion eine komplexe und schwierige Operation, insbesondere die Pankreasanastomose gilt als kompliziert. Des Weiteren sind häufig Gefäßresektionen im Bereich der portalvenösen Achse notwendig. Arterielle Gefäßresektionen werden selten durchgeführt, da sie selten zu einer R0-Situation führen. Nach kompletter Tumorresektion ist die Durchführung einer adjuvanten Chemotherapie als Standard anzusehen. Verstärkt halten auch neoadjuvante Behandlungskonzepte Einzug, weil ein Großteil der Tumoren bei Diagnosestellung lokal irresektabel ist. Fortschritte in der translationalen Forschung führen zum besseren Verständnis der Tumorbiologie. Hier sind in der Zukunft neue Aspekte für die Diagnostik und individualisierte Therapie des Pankreaskarzinoms zu erwarten.
Abstract
Ductal adenocarcinoma is the most frequent malignant tumor of the pancreas and total resection of the pancreatic tumor is still the only curative treatment option. Most tumors are located in the pancreatic head, therefore, pylorus-preserving pancreaticoduodenectomy (Whipple PPPD) is the oncological standard procedure. By concentrating pancreatic resections in specialized centers for pancreatic surgery perioperative mortality and morbidity has decreased in recent years. However, pancreatic resections remain complex and difficult operations and pancreatic anastomosis is particular challenging. To achieve complete resection (R0) resection and reconstruction of large venous vessels is often necessary. Resection of arterial vessels is rarely performed and usually does not lead to an R0 resection of the tumor. Currently adjuvant chemotherapy after total tumor resection is standard of care for all tumor stages but neoadjuvant regimes have recently been reported increasingly more often. Advances in translational research has led to a better understanding of tumor biology and new diagnostic options and therapies are expected in the near future.
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Distler, M., Grützmann, R. Neue Aspekte in der Chirurgie des Pankreaskarzinoms. Pathologe 33 (Suppl 2), 258–265 (2012). https://doi.org/10.1007/s00292-012-1639-z
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DOI: https://doi.org/10.1007/s00292-012-1639-z