Zusammenfassung
GRUNDLAGEN: Die Erfassung der aktuellen Literatur, wissenschaftlichen Evidenz und Therapierichtlinien von Patienten mit Pankreaskarzinom. METHODIK: Übersichtsarbeit zur Therapie des Karzinoms der Bauchspeicheldrüse. ERGEBNISSE: Das Gesamtüberleben mit 5 % nach 5 Jahren ist unverändert schlecht. Die Mehrzahl der Patienten ist bei Diagnosestellung nicht radikal operabel. Durch Senkung der perioperativen Mortalität und Morbidität verbesserte sich die chirurgische Therapie im letzten Jahrzehnt entscheidend. Mortalität < 5 %, chirurgische Komplikationen < 40 %, Reoperationsrate < 10 % und > 80 % R0-Resektionen sind gültige Qualitätsindikatoren. Eine hohe Fallzahl an behandelten Patienten verbessert die Ergebnisqualität signifikant, die Höhe dieses Cut off ist aber nicht genau definiert. Die vielen chirurgisch technischen Variationen der Operation sind einander bezüglich des Ergebnisses ebenbürtig. Die medikamentöse onkologische Therapie ist noch nicht standardisiert, die Evidenz im adjuvanten und neoadjuvanten Setting noch niedrig. Neue Medikamente und Therapieregime geben zwar Hoffnung, müssen ihre Wirksamkeit aber erst in klinischen Studien beweisen. SCHLUSSFOLGERUNGEN: Die klinische Exposition ist entscheidend, um die chirurgischen Qualitätskriterien zu erreichen. Ein standardisiertes onkologisches Therapiekonzept muss in klinischen Studien erarbeitet werden.
Summary
BACKGROUND: To review the diagnosis and therapy of patients with pancreatic cancer, according to recent literature, scientific evidence and treatment guidelines. METHODS: Review on treatment of pancreatic cancer. RESULTS: Over all 5-year survival of 5 % remained poor, a minority of patients resectable at the time of diagnosis. Surgical therapy has improved significantly over the last decade, resulting in a decrease of perioperative mortality and morbidity. Mortality < 5 %, surgical complications < 40 %, reoperation rate < 10 % and R 0 resections > 80 % seem to be valuable benchmarks. Outcome is significantly improved by high case-load of hospitals, but the cut off number is not clearly defined. In contrast, none of the various surgical techniques of reconstruction proves to be superior. Additional oncologic therapy is still in discussion, with poor evidence in the adjuvant and neoadjuvant setting. New drugs and regimen give hope, but have to be standardized and proven in clinical studies. CONCLUSIONS: Clinical exposition is of importance and substantial to reach surgical benchmarks. Studies have to define standardized oncologic, non-surgical treatment.
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Függer, R. Pancreatic carcinoma. Eur Surg 38, 112–117 (2006). https://doi.org/10.1007/s10353-006-0230-3
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DOI: https://doi.org/10.1007/s10353-006-0230-3