S3-Guideline “Exocrine Pancreatic Carcinoma” 2007[1]

Introduction: Scope and aim of the guideline

More than 95 % of pancreatic carcinomas are adenocarcinomas. They develop by malignant degeneration of the exocrine part of the pancreas. According to current knowledge, the pancreatic carcinoma develops from a premalignant stage of the epithelium of the pancreatic duct system (PanIN: pancreatic intraepithelial neoplasia). Cystic tumors that also arise from duct cells and acinar cell carcinoma which develops from secretory pancreatic parenchyma cells are not as common. Even less common are endocrine tumors that arise from endocrine cells in the islets of Langerhans.

About 12 800 people develop pancreatic carcinoma per year in Germany. Men and women are affected with about the same frequency. Pancreatic carcinoma in men takes 9th place and in women 7th place in the statistic of newly developed cancer in Germany. Most of the people that are affected develop the disease at an older age: The mean age at which men and women are diagnosed is 68 and 75 years, respectively. Pancreatic carcinoma with 12 100 deaths was the 5th most common cause of death in the year 2000. Thus, it causes about 6 % of all cancer deaths. The pancreatic carcinoma incidence is very close to its annual mortality rate. Long-term survival is the exception. Thus, the 5-year survival rate for pancreatic carcinoma of 4 % is the lowest of all malignant diseases. The reasons are the late diagnosis, the resulting low curative resection rate, and the rapid and aggressive metastasis.

In the last few years important progress has been made not only in the understanding of pancreatic carcinoma development but also in its diagnosis and therapy. Therefore, it was in the interest of both the DGVS and the German Cancer Society to have a high-quality guideline compiled that is based on the best available scientific evidence and existing clinical experience.

The aim of the guideline “exocrine pancreatic carcinoma” is to ensure an evidence based, comprehensive, and optimal care for patients with pancreatic cancer. The guideline is meant to accomplish:

early diagnosis of pancreatic carcinoma, thus, the possibilty of a higher rate of resections with a curative intent, considerably prolonged survival with a good quality of life in the palliative situation, prolonged survival with a good quality of life in the postoperative situation, strongly improved pain and malnourishment reduction during follow-up.

The guideline addresses anyone involved in the diagnosis, therapy, and follow-up of outpatients or inpatients. According to the definition of guidelines, it is meant to help doctors and patients to decide on diagnostic and therapeutic procedures. The guideline does not release the doctor from his responsibility to individually examine the adequate procedure for the overall situation of each patient. Reasons should be given in case of deviation from the guideline. The physician’s task is to continuously ensure the quality of curative and palliative treatment. This guideline also addresses persons indirectly involved e. g. health care providers or medical services of the health insurance companies.

The methodologic recommendations of the AWMF on the preparation of guidelines (http://www.awmf-leitlinien.de), the guideline manual of the Medical Center of Quality in Medicine (http://www.aezq.de), and the German Instrument on Methodologic Guideline Evaluation (http://www.delbi.de) were the basis for the organization of the guideline procedure. As is demonstrated in the following chapter (guideline report), the guideline fulfills the criteria of an evidence and consensus-based guideline (S3).

This guideline is estimated to be valid for 3 years. If during this time important changes in care become evident, the coordination groups will decide whether individual topics or the complete guideline must be updated ahead of time.

The preparation of the guideline was financially supported by the DGVS and the DKG. The work of the participants taking part in the consensus process and the resulting recommendations were not influenced by this support.

This manuscript is the English version of the German guidelines that were published in the Zeitschrift für Gastroenetrologie in June 2007 [1].

1 Commissioned by the German Society for Digestive and Metabolic Diseases (DGVS) und the German Cancer Society (DKG). In cooperation with the Task Force Radiologic Oncology of the German Cancer Society (ARO), Pancreatectomy Team e. V., German Society for Surgery (DGCH), German Society for Hematology and Oncology (DGHO), German Society for Palliative MedicineGerman Society for Pathology (DGP), German Society for Radiooncology (DEGRO), German Society for Visceral Surgery (CAO-V)/Surgical Task Force Oncology (CAO-V), German Society for Radiology (DRG), German Joint Societies for Clinical Chemistry and Laboratory Medicine (DGKL) (Chairmen: G. Adler, T. Seufferlein, I. Kopp)

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1 Commissioned by the German Society for Digestive and Metabolic Diseases (DGVS) und the German Cancer Society (DKG). In cooperation with the Task Force Radiologic Oncology of the German Cancer Society (ARO), Pancreatectomy Team e. V., German Society for Surgery (DGCH), German Society for Hematology and Oncology (DGHO), German Society for Palliative MedicineGerman Society for Pathology (DGP), German Society for Radiooncology (DEGRO), German Society for Visceral Surgery (CAO-V)/Surgical Task Force Oncology (CAO-V), German Society for Radiology (DRG), German Joint Societies for Clinical Chemistry and Laboratory Medicine (DGKL) (Chairmen: G. Adler, T. Seufferlein, I. Kopp)