Metachrone Pankreasmetastasen - Operative Therapie?

Zusammenfassung

Die Entscheidung, Patienten mit Pankreasmetastasen zu operieren, hängt von einer Risikoabwägung ab. Hierbei geht das perioperative Risiko auf der einen, die Chance auf Heilung oder adäquate Palliation auf der anderen Seite in die Kalkulation ein. Methode: Retrospektive Analyse von 10 eigenen Fällen anhand der Krankenakten sowie der Befragung der Patienten. Ergebnisse: 8 von 10 Patienten konnten mit kurativer Intention operiert werden. Primärtumoren waren Nierenzellkarzinome (n = 4), kolorektale Karzinome (n = 4), Melanom (n = 1) und Leiomyosarkom (n = 1). 5 Patienten leben bis zu 10 Jahren nach Pankreasmetastasenresektion. Lediglich 2 Patienten sind tumorfrei geblieben. Alle Patienten mit Pankreasmetastasen kolorektaler Karzinome sind mittlerweile verstorben. Schlussfolgerung: Ein aggresiver operativer Therapieansatz ist bei Patienten mit Pankreasmetastasen im Einzelfall gerechtfertigt. Die Chance auf Langzeitüberleben hängt wohl mit der primären Tumorentität zusammen. Die Prognose scheint besser zu sein als bei primären Pankreaskarzinomen.

Abstract

Background: The decision to operate on patients with malignant metastatic diseases depends on the calculation of perioperative risk versus chance of cure or adaequate palliation. In the rare case of metastastis to the pancreas it is questionable whether aggressive surgery is justified. Method: We retrospectively reviewed the medical records of 10 patients with metastatic disease to the pancreas of different origin. Results: 8 of the 10 patients were operated with curative intent. In all patients major surgical procedures were done with respect to the localization. The primaries were renal cell carcinoma (n = 4), colorectal carcinoma (n = 4), melanoma (n = 1) and leiomyosarcoma. 5 patients are still alive up to 10 years after resection of pancreatic metastasis. However, only 2 patients have had no further recurrence. The primaries in these 2 patients were melanoma and leiomyosarcoma. All patients with colorectal primary have died meanwhile. Conclusions: Aggressive surgery in metastatic disease to the pancreas is justified in selected patients. The chance for long-time survival depends on the primary tumor site. Prognosis in general seems to be better than in primary pancreatic cancer.

Schlüsselwörter

Pankreasmetastasen - Pankreasresektion - Überleben

Key words

Pancreatic metastases - pancreatic resection - survival

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