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Z Gastroenterol 2017; 55(02): 140-144
DOI: 10.1055/s-0042-118716
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Kurz- und Langzeitergebnisse bei operablen duktalen Pankreasadenokarzinomen aus der Kooperation zwischen zwei Abteilungen Gastroenterologie-Viszeralchirurgie an nicht universitären Kliniken im Vergleich mit Resultaten aus Spitzenzentren

Short- and long-term results in operable pancreatic ductal adenocarcinomas from a cooperation between two departments gastroenterology-visceral surgery at non-university hospitals benchmarked to results of expert-centers
Wolfgang Dippold
1   Medizinische Klinik St. Vincenz-Elisabeth Krankenhaus Mainz, Germany
,
Visvakanth Sivanathan
1   Medizinische Klinik St. Vincenz-Elisabeth Krankenhaus Mainz, Germany
3   Medizinische Klinik I. Universitätsmedizin Mainz, Germany
,
Katharina Statt
2   Chirurgisches Zentrum Asklepios Paulinen Klinik Wiesbaden, Germany
,
Marc Roitman
2   Chirurgisches Zentrum Asklepios Paulinen Klinik Wiesbaden, Germany
,
Karl Heinrich Link
2   Chirurgisches Zentrum Asklepios Paulinen Klinik Wiesbaden, Germany
› Author Affiliations
Further Information

Publication History

20 July 2016

04 October 2016

Publication Date:
22 November 2016 (online)

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Zusammenfassung

Der einzig kurative Ansatz beim duktalen Adenokarzinom des Pankreas ist die Resektion des Tumors, die nur bei 15 – 30 % der Patienten möglich ist. Die lokale Tumorausbreitung oder Fernmetastasen machen in den meisten Fällen eine Operation obsolet. Die chirurgisch-onkologische Behandlungsqualität mit Kurz- und Langzeitergebnissen zeigt eine erhebliche Variationsbreite, sodass „Expertise/Qualität“ mit Mindestmengen und Zentrierung assoziiert werden. Ziel unserer retrospektiven Studie war es, die Ergebnisqualität der Behandlung von Patienten mit Pankreaskarzinomen auf der Basis einer ausführlichen präoperativen Diagnostik an einer Klinik mit GI-Schwerpunkt und der Kooperation mit einem Viszeralchirurgen bzw. Team mit chirurgisch-onkologischer Expertise in der Pankreaschirurgie an einer nicht universitären Versorgungsklinik zu untersuchen und mit Resultaten der Spitzenzentren zu vergleichen. 53 Patienten mit duktalem Pankreasadenokarzinom wurden von 1/2002 – 12/2009 operiert. Die 30-Tage-Krankenhausmortalität betrug 3,8 %, die mediane Überlebenszeit der operierten Patienten nach Entlassung aus dem Krankenhaus 23,1 Monate. Die 5-Jahres-Überlebensrate R0-resezierter Patienten, die alle adjuvant chemotherapiert wurden, war mit 31 % hoch. Die Überlebenszeiten und die außerordentlich hohe Resektionsquote von 98,1 % bei Patienten, deren Tumoren überwiegend als T3 (81 %) eingestuft wurden, zeigen die besonders erfolgreiche Zusammenarbeit zwischen gastroenterologischer Diagnostik, viszeraler Pankreaschirurgie und onkologischer Nachbehandlung. Die Ergebnisse sind mit denen von sog. „High-Volume-Zentren“ vergleichbar. Die verantwortlichen Ärzte beider Abteilungen wurden an universitären Spitzenzentren ausgebildet. Expertise ist bei entsprechender Team-Konstellation von einem Spitzenzentrum an ein nicht universitäres Versorgungskrankenhaus übertragbar.

Abstract

The only curative approach in pancreatic ductal adenocarcinoma (PDAC) is resection, which is possible only in 15 – 30 % of patients. Local tumor spread or distant metastases are contraindications for resection in the majority of patients. Surgical-oncological quality with short- and long-term results are varying tremendously, so that “expertise/quality” are associated to hospital- or surgeon’s volume and/or center formation. The treatment results also depend, to a great extent, on the medical diagnostic quality. With our retrospective study, we aim to compare the results-quality of cooperative pancreatic cancer treatment based on an extensive preoperative diagnostic procedure for staging and risk estimation in a specialized GI-medical department and visceral surgical-oncological expertise in pancreatic cancer surgery at a general hospital with the results-quality of expert centers. Fifty-three patients with PDAC had diagnosis and resection of their cancer between 1/2002 and 12/2009. The 30 day hospital-mortality was 3.8 % and the median survival time after demission from the hospital was 23.1 months. The 5-year-survival rate of R0-resected patients, all of whom had received adjuvant chemotherapy, was high with 31 %. The survival data and the extraordinarily high resection rate of 98.1 % in the patient group, whose primary tumor stage was pT3 in 81 %, reflects the excellent cooperation of high standards in medical diagnostic processes, visceral pancreatic surgery, and adjuvant medical chemotherapy. The results are well comparable to those of “high volume centers”. The responsible heads of the two departments have been trained at university expert centers. Expertise in the treatment of pancreatic cancer patients may be successfully transferred from an expert center to a general hospital, if the team has high expertise.

Schlüsselwörter

Kooperation - Ergebnisse - Qualität - Benchmark - duktales Adeno-Karzinom des Pankreas

Key words

cooperation - results - quality - benchmarking - pankreatic ductal adenocarcinoma
 

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