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Viszeralchirurgie 2001; 36(1): 20-28
DOI: 10.1055/s-2001-11140
ORIGINALARBEIT
© Georg Thieme Verlag Stuttgart · New York

Aktueller Stand multimodaler Therapiekonzepte beim Pankreaskarzinom

O. Horstmann1 , P. M. Markus1 , W. Nolte3 , H. Schmidberger2 , H. Becker1
  • 1Klinik für Allgemeinchirurgie
  • 2Klinik für Strahlentherapie
  • 3Klinik für Gastroenterologie, Universitätsklinikum Göttingen
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Publication History

Publication Date:
31 December 2001 (online)

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Hintergrund

Das Karzinom der exokrinen Bauchspeicheldrüse stellt mit etwa 3 - 6 % aller Krebstodesfälle in Industrieländern die viert- oder fünfthäufigste Todesursache dar [1], wobei die Inzidenz auch in europäischen Ländern bis Ende der achtziger Jahre stetig zugenommen hat [2].

Trotz überzeugender Fortschritte in der chirurgischen Behandlung dieser Krebserkrankung ist die Prognose nach wie vor deprimierend schlecht. In der in diesem Zusammenhang wahrscheinlich meistzitierten Sammelstatistik, deren fortbestehende Gültigkeit heute gelegentlich angezweifelt wird, scheint nur jeder zehnte Krebs resektabel, wobei nur 0,4 % der so operierten Patienten 5 weitere Jahre überleben [3].

Unter dem Begriff „Pankreaskarzinom” wird in der Regel wegen nahezu identischer operativer Therapieverfahren nicht nur das eigentliche, duktale Adenokarzinom der Bauchspeicheldrüse verstanden. Trotz signifikant besserer Prognose werden unter dem Sammelbegriff „periampulläres Karzinom” zusätzlich die deutlich selteneren Duodenal-, Papillen- und distalen Choledochuskarzinome subsumiert und teilweise analog zum duktalen Pankreaskarzinom in Studien oder Publikationen behandelt. Hiervon kann auch in der vorliegenden Übersichtsarbeit nicht wesentlich abgewichen werden, wobei den Autoren durchaus bewusst ist, dass die verschiedenen Tumorentitäten u. U. nicht vergleichbar sind.

Nichts desto weniger wird anhand der o. g. Prognose der Erkrankung nach alleiniger Resektion, so überhaupt möglich, doch die dringende Notwendigkeit einer Therapieoptimierung deutlich. Ziel dieser Übersicht ist es, stattgehabte und mögliche Verbesserungen in der Behandlung des Bauchspeicheldrüsenkrebses aufzuzeigen. Hierbei soll der Schwerpunkt nicht auf die zahlenmäßig wahrscheinlich häufigere palliative Therapie beim metastasierten oder irresektablen Tumor gelegt werden. Vielmehr soll hauptsächlich erörtert werden, ob und auf welche Weise die Prognose des potentiell kurativ zu behandelnden Krebses in einem multimodalen Konzept aus chirurgischer, onkologischer und radiotherapeutischer Behandlung zu verbessern sein könnte.

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Prof. Dr. med. H. Becker

Direktor der Klinik für AllgemeinchirurgieUniversitätsklinikum Göttingen

Robert-Koch-Straße 40

37075 Göttingen

Phone: + 49-551-396170

Fax: + 49-551-396106

Email: ohorstm@med.uni-goettingen.de