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DOI: 10.1055/s-2007-960664
© Georg Thieme Verlag Stuttgart · New York
Chirurgie des Pankreaskarzinoms - Qualitätssicherung
Surgery of Pancreatic Cancer - Quality ManagementPublication History
Publication Date:
22 May 2007 (online)
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Zusammenfassung
Patienten mit einem Pankreaskarzinom haben häufig eine schlechte Prognose. Die Frage einer Qualitätssicherung der onkologischen Behandlung dieser Erkrankung scheint daher hinter der aggressiven Tumorbiologie auf den ersten Blick zurückzustehen. Interessanterweise belegen zahlreiche Studien und Daten, dass die Qualität der onkologischen Therapie beim Pankreaskarzinom stark von der Erfahrung und dem Patientenaufkommen der behandelnden Klinik abhängen. Dabei spielen nicht nur der Operateur sondern auch die Erfahrung des Pathologen, Onkologen, Radiologen und des gesamten multidisziplinären Behandlungsteams eine wichtige Rolle. Die Behandlung des Pankreaskarzinoms sollte nur an erfahrenen und spezialisierten Zentren erfolgen, um die Qualität der onkologischen Versorgung bei dieser Erkrankung sicherzustellen und damit auch die Langzeitprognose der Patienten zu verbessern.
Abstract
Patients with pancreatic cancer usually have a poor prognosis. Therefore, it remains questionable whether quality control of the oncological treatment of pancreatic cancer patients is of any importance compared to the aggressive tumor biology. Interestingly, numerous studies and data revealed a clear relationship between hospital volume and outcome for patients with pancreatic cancer. Beside surgeon's experience, the experience and quality of the treating pathologist, oncologist, radiologist and the whole multidisciplinary team also seems to play an important role. Pancreatic cancer should only be treated in experienced and specialised centers in order to provide adequate oncological therapy and to improve long term prognosis of the patients.
Schlüsselwörter
Qualitätssicherung - Onkologie - Chirurgie - Pankreaskarzinom
Key words
Quality control - surgical oncology - pancreatic cancer
Literatur
- 1 Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun M J. Cancer statistics, 2006. CA Cancer J Clin. 2006; 56 106-130
- 2 Chua Y J, Cunningham D. Adjuvant treatment for resectable pancreatic cancer. J Clin Oncol. 2005; 23 4532-4537
- 3 Neoptolemos J P, Stocken D D, Dunn J A. et al . Influence of resection margins on survival for patients with pancreatic cancer treated by adjuvant chemoradiation and / or chemotherapy in the ESPAC-1 randomized controlled trial. Ann Surg. 2001; 234 758-768
- 4 Neoptolemos J P, Dunn J A, Stocken D D. et al . Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. Lancet. 2001; 358 1576-1585
- 5 Albores-Saavedra J, Heffess C, Hruban R H, Klimstra D, Longnecker D. Recommendations for the reporting of pancreatic specimens containing malignant tumors. The Association of Directors of Anatomic and Surgical Pathology. Am J Clin Pathol. 1999; 111 304-307
- 6 Lüttges J, Zamboni G, Klöppel G. Recommendation for the examination of pancreaticoduodenectomy specimens removed from patients with carcinoma of the exocrine pancreas. Dig Surg. 1999; 16 291-296
- 7 Lüttges J, Vogel I, Menke M. et al . The retroperitoneal resection margin and vessel involvement are important factors determining survival after pancreaticoduodenectomy for ductal adenocarcinoma of the head of the pancreas. Virch Arch. 1998; 433 237-242
- 8 Verbeke C S, Leitch D, Menon K V, McMahon M J, Guillou P J, Anthoney A. Redefining the R1 resection in pancreatic cancer. Br J Surg. 2006; 93 1232-1237
- 9 Neoptolemos J P, Stocken D D, Friess H. et al . A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004; 350 1200-1210
- 10 Kuhlmann K, de Castro S, van Heek T. et al . Microscopically incomplete resection offers acceptable palliation in pancreatic cancer. Surgery. 2006; 139 188-196
- 11 Chaudry I H, Campbell F. An audit of pathology lymph node dissection techniques in pylorus preserving Kausch-Whipple pancreatoduodenectomy specimens. J Clin Pathol. 2001; 54 758-761
- 12 Lüttges J, Schemm S, Vogel I, Hedderich J, Kremer B, Klöppel G. The grade of pancreatic ductal carcinoma is an independent prognostic factor and is superior to the immunohistochemical assessment of proliferation. J Pathol. 2000; 191 154-161
- 13 Oettle H, Post S, Neuhaus P. et al . Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer. JAMA. 2007; 297 267-277
- 14 Riall T S, Nealon W H, Goodwin J S. et al . Pancreatic cancer in the general population: improvements in survival over the last decade. J Gastrointest Surg. 2006; 10 1212-1224
- 15 Sohn T A, Yeo C J, Cameron J L. et al . Resected adenocarcinoma of the pancreas - 616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg. 2000; 4 567-579
- 16 Geer R J, Brennan M F. Prognostic indicators for survival after resection of pancreatic adenocarcinoma. Am J Surg. 1993; 165 68-72
- 17 Buchler M W, Friess H, Wagner M, Kulli C, Wagener V, Z'Graggen K. Pancreatic fistula after pancreatic head resection. Br J Surg. 2000; 87 883-889
- 18 Riall T S, Cameron J L, Lillemoe K D. et al . Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma - part 3: update on 5-year survival. J Gastrointest Surg. 2005; 9 1191-1204 , discussion 1204-1206
- 19 Winter J M, Cameron J L, Campbell K A. et al . 1 423 Pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg. 2006; 10 1199-1211
- 20 Friess H, Kleeff J, Fischer L, Muller M, Buchler M W. Surgical standard therapy for cancer of the pancreas. Chirurg. 2003; 74 183-190
- 21 Alexakis N, Halloran C, Raraty M, Ghaneh P, Sutton R, Neoptolemos J P. Current standards of surgery for pancreatic cancer. Br J Surg.. 2004; 91 1410-1427
- 22 Wray C J, Ahmad S A, Matthews J B, Lowy A M. Surgery for pancreatic cancer: recent controversies and current practice. Gastroenterology. 2005; 128 1626-1641
- 23 Kausch W. Das Karzinom der Papilla duodeni und seine radikale Entfernung. Beitr Klin Chir. 1912; 78 439
- 24 Whipple A O, Parsons W B, Mullins C R. Treatment of carcinoma of the ampulla of Vater. Ann Surg. 1935; 102 763
- 25 Traverso L W, Longmire Jr W P. Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet.. 1978; 146 959-962
- 26 Traverso L W, Longmire Jr W P. Preservation of the pylorus in pancreaticoduodenectomy a follow-up evaluation. Ann Surg. 1980; 192 306-310
- 27 Seiler C A, Wagner M, Bachmann T. et al . Randomized clinical trial of pylorus-preserving duodenopancreatectomy versus classical Whipple resection-long term results. Br J Surg. 2005; 92 547-556
- 28 Tran K T, Smeenk H G, van Eijck C H. et al . Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg. 2004; 240 738-745
- 29 Diener M K, Knaebel H P, Heukaufer C, Antes G, Büchler M W, Seiler C M. A systematic review and meta-analysis of pylorus-preserving versus classical pancreaticoduodenectomy for surgical treatment of periampullary and pancreatic carcinoma. Ann Surg. 2007; 245 187-200
- 30 Knaebel H P, Diener M K, Wente M N, Büchler M W, Seiler C M. Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg. 2005; 92 539-546
- 31 Bramhall S R, Allum W H, Jones A G, Allwood A, Cummins C, Neoptolemos J P. Treatment and survival in 13,560 patients with pancreatic cancer, and incidence of the disease, in the West Midlands: an epidemiological study. Br J Surg. 1995; 82 111-115
- 32 Yeo C J, Cameron J L, Sohn T A. et al . Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997; 226 248-257
- 33 Luft H S, Bunker J P, Enthoven A C. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med.. 1979; 301 1364-1369
- 34 Birkmeyer J D, Siewers A E, Finlayson E V. et al . Hospital volume and surgical mortality in the United States. N Engl J Med.. 2002; 346 1128-1137
- 35 Finlayson E V, Birkmeyer J D. Effects of hospital volume on life expectancy after selected cancer operations in older adults: a decision analysis. J Am Coll Surg. 2003; 196 410-417
- 36 Birkmeyer J D, Dimick J B, Staiger D O. Operative mortality and procedure volume as predictors of subsequent hospital performance. Ann Surg. 2006; 243 411-417
- 37 Birkmeyer J D, Stukel T A, Siewers A E, Goodney P P, Wennberg D E, Lucas F L. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003; 349 2117-2127
- 38 Weitz J, Koch M, Friess H, Büchler M W. Impact of volume and specialization for cancer surgery. Dig Surg. 2004; 21 253-261
- 39 Birkmeyer J D, Dimick J B. Potential benefits of the new Leapfrog standards: effect of process and outcome measures. Surgery. 2004; 135 569-575
- 40 van Heek N T, Kuhlmann K F, Scholten R J. et al . Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg. 2005; 242 781-788
- 41 Wagner M, Redaelli C, Lietz M, Seiler C A, Friess H, Buchler M W. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg. 2004; 91 586-594
- 42 Pedrazzoli S, DiCarlo V, Dionigi R. et al . Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg. 1998; 228 508-517
- 43 Yeo C J, Cameron J L, Lillemoe K D. et al . Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg. 2002; 236 355-366
- 44 Bentrem D J, Brennan M F. Outcomes in oncologic surgery: does volume make a difference?. World J Surg. 2005; 29 1210-1216
- 45 Fong Y, Gonen M, Rubin D, Radzyner M, Brennan M F. Long-term survival is superior after resection for cancer in high-volume centers. Ann Surg. 2005; 242 540-544
- 46 Leach S D, Lee J E, Charnsangavej C. et al . Survival following pancreaticoduodenectomy with resection of the superior mesenteric-portal vein confluence for adenocarcinoma of the pancreatic head. Br J Surg. 1998; 85 611-617
- 47 Bachellier P, Nakano H, Oussoultzoglou P D. et al . Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile?. Am J Surg. 2001; 182 120-129
- 48 Nakagohri T, Kinoshita T, Konishi M, Inoue K, Takahashi S. Survival benefits of portal vein resection for pancreatic cancer. Am J Surg. 2003; 186 149-153
- 49 van Geenen R C, ten Kate F J, de Wit L T, van Gulik T M, Obertop H, Gouma D J. Segmental resection and wedge excision of the portal or superior mesenteric vein during pancreatoduodenectomy. Surgery. 2001; 129 158-163
Prof. Dr. J. WeitzMSc
Sektion Chirurgische Onkologie
Im Neuenheimer Feld 110
69120 Heidelberg
Phone: 0 62 21/56 62 50
Fax: 0 62 21/56 55 06
Email: Jürgen.Weitz@med.uni-heidelberg.de