Pankreaskarzinom – Chirurgie im Wandel der multimodalen Therapiemöglichkeiten

Diese zweiteilige Übersichtsarbeit fasst die evidenzbasierten aktuellen Standards in der Versorgung von Patienten mit Pankreaskarzinom zusammen: Im 1. Teil wurden die Pathologie, die Ätiologie sowie das diagnostische Vorgehen dargestellt und die epidemiologischen Fakten zusammengefasst [1]. Dieser 2. Teil widmet sich den therapeutischen Prinzipien und Möglichkeiten.

Kernaussagen

• Die Prognose des duktalen Adenokarzinom des Pankreas („pancreatic ductal adenocarcinoma“, PDAC) ist mit einer 5-Jahres-Überlebensrate von unter 10% die schlechteste unter allen Krebsarten.

• Der einzig kurative Einsatz bleibt die radikale chirurgische Resektion als Duodenohemipankreatektomie, Pankreaslinksresektion oder totale Duodenopankreatektomie mit entsprechender Lymphknotendissektion.

• Der Einsatz der chemotherapeutischen Regimes Folfirinox und Gemcitabin/nab-Paclitaxel in multimodalen Konzepten hat die Überlebenszeiten im adjuvanten und palliativen Setting deutlich verlängert, aber auch die Resektionsraten und Überlebenschancen bei lokal fortgeschrittenen Pankreaskarzinomen wesentlich erhöht.

• Eine spürbare Verbesserung der immer noch schlechten Langzeitprognose kann nur durch Weiterentwicklung der frühzeitigen Diagnostik und Etablierung individualisierter Therapiestrategien erreicht werden – auf jeden Fall wird die Therapie des exokrinen Pankreaskarzinoms multimodal.

Schlüsselwörter

Onkologie - Bauchspeicheldrüsenkrebs - Malignom - Tumorerkrankung - Tumorchirurgie - Chemotherapie

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