Therapie des Pankreaskopfkarzinoms

Zusammenfassung

Auch beim Pankreaskopfkarzinom stellt die chirurgische Therapie die einzige Chance auf Heilung dar. Die perioperative Mortalität konnte in den letzten Jahren dramatisch verringert werden. Die postoperative Morbidität ist aber immer noch hoch. Von allen an einem Pankreaskopfkarzinom erkrankten Patienten kommt nur ein kleiner Prozentsatz für eine Operation infrage. Die häufigste Kontraindikation für eine Operation stellt ein systemisch bereits metastasierter oder lokal zu weit fortgeschrittener Tumor dar. Das Ausmaß der chirurgischen Radikalität beim operablen Pankreaskopfkarzinom wird unterschiedlich beurteilt. Trotz kurativer Intention sind die Langzeitergebnisse nach Resektion eine Pankreaskopfkarzinoms immer noch schlecht. Die mittlere Überlebenszeit liegt bei etwa 16 Monaten. Eine Verbesserung dieser Situation kann nur von neuen multimodalen Therapiestrategien erwartet werden. Während die adjuvante Chemotherapie nach Resektion eines Pankreaskopfkarzinoms dringend empfohlen werden muss, stellt die neoadjuvante Therapie weiterhin ein experimentelles Verfahren dar und wird im Moment in Studien evaluiert.

Abstract

For patients with carcinoma in the head of the pancreas surgical resection remains the only chance of cure. Perioperative mortality could be reduced in the last years dramatically, postoperative morbidity, however, remains high. Only a small percentage of all patients suffering from pancreas carcinoma are good candidates for an operative therapy. The most frequent contraindications are metastases in the liver or the peritoneum or a locally too advanced tumor. The extent of surgical resection necessary in patients with pancreas carcinoma is still in discussion. Even after an operation under curative aspects long term results remain disappointing. Median survival still ranges only about 16 months. A substantial improvement of long term- survival can only be expected from new multimodal therapeutic strategies. Adjuvant chemotherapy should strongly be recommended after resection of a pancreas carcinoma. Neoadjuvant therapy on the other hand is still an experimental procedure and under evaluation in ongoing prospective randomized studies.

Schlüsselwörter

Pankreaskopfkarzinom - Operation - adjuvante Therapie - neoadjuvante Therapie

Key words

pancreas head carcinoma - surgery - adjuvant therapy - neoadjuvant therapy

Literatur

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