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Erschienen in: European Surgery 5/2013

01.10.2013 | Short Communication

4th Austrian pancreas day: a summary of the surgical management of exocrine pancreatic neoplasms

verfasst von: K. Sahora, M. Schindl, M. Gnant

Erschienen in: European Surgery | Ausgabe 5/2013

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Summary

Background

In the twenty-first century management of pancreatic diseases remains a challenge for surgeons, gastroenterologists, anesthesiologists, pathologists, radiologists, and oncologists. While the techniques of pancreatic resections have not changed within the last decades, nowadays multimodal neoadjuvant treatment strategies offer curative surgical therapy to a higher percentage of patients. Furthermore, new knowledge has emerged about the biology and treatment of cystic lesions of the pancreas.

Methods

We summarized the surgical topics of the upcoming meeting entitled “4th Austrian Pancreas Day”.

Results

Even after decades of intense research the ductal adenocarcinoma of the pancreas stays a deadly disease. A curative R0 resection remains the only treatment potentially prolonging overall survival. Esposito et al. as well as Verbeke et al. demonstrated that axial slicing and extensive tissue sampling, raises the R1 resection rate up to 85 %, compared to R1 rates of 10–20 % in older series with basic pathological workup. In locally and advanced and borderline resectable pancreatic cancer, novel chemotherapeutic regimes like Folfirinox in combination with or without radiotherapy proved to offer satisfying response rates, making curative resection feasible in more patients. At the same time, the number of patients incidentally diagnosed with cystic lesion of the pancreas is continuously rising. However, only some of these patients need pancreatic surgery while others can be safely observed. In 2012 the International Association of Pancreatology has revised their guidelines for the management of mucinous cystic neoplasms and intraductal papillary mucinous neoplasms, deemphasizing cyst size as a worrisome feature.

Conclusions

Today, patients with pancreatic neoplasms need to be managed by an experienced interdisciplinary team. In such professional setting it should by our goal to curatively resect as much as possible patients with pancreatic malignancies and at the same time reduce the number of unnecessary operations of benign cystic neoplasms.
Literatur
1.
Zurück zum Zitat Alexakis N, Halloran C, Raraty M, et al. Current standards of surgery for pancreatic cancer. Br J Surg. 2004;91(11):1410–27.PubMedCrossRef Alexakis N, Halloran C, Raraty M, et al. Current standards of surgery for pancreatic cancer. Br J Surg. 2004;91(11):1410–27.PubMedCrossRef
2.
Zurück zum Zitat Buchler MW, Wagner M, Schmied BM, et al. Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg. 2003;138(12):1310–4 (discussion 1315). Buchler MW, Wagner M, Schmied BM, et al. Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg. 2003;138(12):1310–4 (discussion 1315).
3.
Zurück zum Zitat Carpelan-Holmstrom M, Nordling S, Pukkala E, et al. Does anyone survive pancreatic ductal adenocarcinoma? A nationwide study re-evaluating the data of the Finnish Cancer Registry. Gut. 2005;54(3):385–7.PubMedCrossRef Carpelan-Holmstrom M, Nordling S, Pukkala E, et al. Does anyone survive pancreatic ductal adenocarcinoma? A nationwide study re-evaluating the data of the Finnish Cancer Registry. Gut. 2005;54(3):385–7.PubMedCrossRef
4.
Zurück zum Zitat Diener MK, Knaebel HP, Heukaufer C, et al. A systematic review and meta-analysis of pylorus-preserving versus classical pancreaticoduodenectomy for surgical treatment of periampullary and pancreatic carcinoma. Ann Surg. 2007;245(2):187–200.PubMedCrossRef Diener MK, Knaebel HP, Heukaufer C, et al. A systematic review and meta-analysis of pylorus-preserving versus classical pancreaticoduodenectomy for surgical treatment of periampullary and pancreatic carcinoma. Ann Surg. 2007;245(2):187–200.PubMedCrossRef
5.
Zurück zum Zitat Friess H, Kleeff J, Kulli C, et al. The impact of different types of surgery in pancreatic cancer. Eur J Surg Oncol. 1999;25(2):124–31.PubMedCrossRef Friess H, Kleeff J, Kulli C, et al. The impact of different types of surgery in pancreatic cancer. Eur J Surg Oncol. 1999;25(2):124–31.PubMedCrossRef
6.
7.
Zurück zum Zitat Hartel M, Wente MN, Hinz U, et al. Effect of antecolic reconstruction on delayed gastric emptying after the pylorus-preserving Whipple procedure. Arch Surg. 2005;140(11):1094–9.PubMedCrossRef Hartel M, Wente MN, Hinz U, et al. Effect of antecolic reconstruction on delayed gastric emptying after the pylorus-preserving Whipple procedure. Arch Surg. 2005;140(11):1094–9.PubMedCrossRef
8.
Zurück zum Zitat Kleeff J, Reiser C, Hinz U, et al. Surgery for recurrent pancreatic ductal adenocarcinoma. Ann Surg. 2007;245(4):566–72.PubMedCrossRef Kleeff J, Reiser C, Hinz U, et al. Surgery for recurrent pancreatic ductal adenocarcinoma. Ann Surg. 2007;245(4):566–72.PubMedCrossRef
9.
Zurück zum Zitat Park YC, Kim SW, Jang JY, et al. Factors influencing delayed gastric emptying after pylorus-preserving pancreatoduodenectomy. J Am Coll Surg. 2003;196(6):859–65.PubMedCrossRef Park YC, Kim SW, Jang JY, et al. Factors influencing delayed gastric emptying after pylorus-preserving pancreatoduodenectomy. J Am Coll Surg. 2003;196(6):859–65.PubMedCrossRef
10.
Zurück zum Zitat 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(4):508–17.PubMedCrossRef 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(4):508–17.PubMedCrossRef
11.
Zurück zum Zitat Pedrazzoli S, Pasquali C, Sperti C. Role of surgery in the treatment of bilio-pancreatic cancer: the European experience. Semin Oncol.2002;29(6 Suppl 20):23–30. Pedrazzoli S, Pasquali C, Sperti C. Role of surgery in the treatment of bilio-pancreatic cancer: the European experience. Semin Oncol.2002;29(6 Suppl 20):23–30.
12.
Zurück zum Zitat Schafer M, Mullhaupt B, Clavien PA. Evidence-based pancreatic head resection for pancreatic cancer and chronic pancreatitis. Ann Surg. 2002;236(2):137–48.PubMedCrossRef Schafer M, Mullhaupt B, Clavien PA. Evidence-based pancreatic head resection for pancreatic cancer and chronic pancreatitis. Ann Surg. 2002;236(2):137–48.PubMedCrossRef
13.
Zurück zum Zitat Stojadinovic A, Brooks A, Hoos A, et al. An evidence-based approach to the surgical management of resectable pancreatic adenocarcinoma. J Am Coll Surg. 2003;196(6):954–64.PubMedCrossRef Stojadinovic A, Brooks A, Hoos A, et al. An evidence-based approach to the surgical management of resectable pancreatic adenocarcinoma. J Am Coll Surg. 2003;196(6):954–64.PubMedCrossRef
14.
Zurück zum Zitat Tani M, Terasawa H, Kawai M, et al. Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy: results of a prospective, randomized, controlled trial. Ann Surg. 2006;243(3):316–20.PubMedCrossRef Tani M, Terasawa H, Kawai M, et al. Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy: results of a prospective, randomized, controlled trial. Ann Surg. 2006;243(3):316–20.PubMedCrossRef
15.
Zurück zum Zitat Wagner M, Redaelli C, Lietz M, et al. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg. 2004;91(5):586–94.PubMedCrossRef Wagner M, Redaelli C, Lietz M, et al. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg. 2004;91(5):586–94.PubMedCrossRef
16.
Zurück zum Zitat White RR, Shah AS, Tyler DS. Pancreatic cancer since Halsted: how far have we come and where are we going? Ann Surg. 2003;238(6 Suppl):132–44 (Discussion S145–7). White RR, Shah AS, Tyler DS. Pancreatic cancer since Halsted: how far have we come and where are we going? Ann Surg. 2003;238(6 Suppl):132–44 (Discussion S145–7).
17.
Zurück zum Zitat Yeo CJ, Cameron JL, Sohn TA, et al. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann Surg. 1999;229(5):613–22 (Discussion 622–4). Yeo CJ, Cameron JL, Sohn TA, et al. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann Surg. 1999;229(5):613–22 (Discussion 622–4).
18.
Zurück zum Zitat Z’Graggen K, Uhl W, Friess H, Buchler MW. How to do a safe pancreatic anastomosis. J Hepatobiliary Pancreat Surg. 2002;9(6):733–7.PubMedCrossRef Z’Graggen K, Uhl W, Friess H, Buchler MW. How to do a safe pancreatic anastomosis. J Hepatobiliary Pancreat Surg. 2002;9(6):733–7.PubMedCrossRef
19.
Zurück zum Zitat Sultana A, Tudur Smith C, Cunningham D, et al. Systematic review, including meta-analyses, on the management of locally advanced pancreatic cancer using radiation/combined modality therapy. Br J Cancer. 2007;96:1183–90.PubMedCrossRef Sultana A, Tudur Smith C, Cunningham D, et al. Systematic review, including meta-analyses, on the management of locally advanced pancreatic cancer using radiation/combined modality therapy. Br J Cancer. 2007;96:1183–90.PubMedCrossRef
20.
Zurück zum Zitat Sa Cunha A, Rault A, Laurent C, et al. Surgical resection after radiochemotherapy in patients with unresectable adenocarcinoma of the pancreas. J Am Coll Surg. 2005;201:359–65.PubMedCrossRef Sa Cunha A, Rault A, Laurent C, et al. Surgical resection after radiochemotherapy in patients with unresectable adenocarcinoma of the pancreas. J Am Coll Surg. 2005;201:359–65.PubMedCrossRef
21.
Zurück zum Zitat Castillo CF, Adsay NV. Intraductal papillary mucinous neoplasms of the pancreas. YGAST. 2011;139(3):708–13.e2. Castillo CF, Adsay NV. Intraductal papillary mucinous neoplasms of the pancreas. YGAST. 2011;139(3):708–13.e2.
22.
Zurück zum Zitat Fernandez-Del Castillo C. Surgical treatment of intraductal papillary mucinous neoplasms of the pancreas: the conservative approach. J Gastrointest Sur. 2002;6(5):660–1.CrossRef Fernandez-Del Castillo C. Surgical treatment of intraductal papillary mucinous neoplasms of the pancreas: the conservative approach. J Gastrointest Sur. 2002;6(5):660–1.CrossRef
23.
Zurück zum Zitat Matthaei H, Norris AL, Tsiatis AC, et al. Clinicopathological characteristics and molecular analyses of multifocal Intraductal Papillary Mucinous Neoplasms of the Pancreas. Ann Sur. 2012;255(2):326–33.CrossRef Matthaei H, Norris AL, Tsiatis AC, et al. Clinicopathological characteristics and molecular analyses of multifocal Intraductal Papillary Mucinous Neoplasms of the Pancreas. Ann Sur. 2012;255(2):326–33.CrossRef
24.
Zurück zum Zitat Mino-Kenudson M, Fernandez-Del Castillo C, Baba Y, et al. Prognosis of invasive intraductal papillary mucinous neoplasm depends on histological and precursor epithelial subtypes. Gut. 2011;60(12):1712–20.PubMedCrossRef Mino-Kenudson M, Fernandez-Del Castillo C, Baba Y, et al. Prognosis of invasive intraductal papillary mucinous neoplasm depends on histological and precursor epithelial subtypes. Gut. 2011;60(12):1712–20.PubMedCrossRef
25.
Zurück zum Zitat Partelli S, Fernandez-Del Castillo C, Bassi C, et al. Invasive Intraductal Papillary Mucinous Carcinomas of the Pancreas. Ann Surg. 2010;251(3):477–82.PubMedCrossRef Partelli S, Fernandez-Del Castillo C, Bassi C, et al. Invasive Intraductal Papillary Mucinous Carcinomas of the Pancreas. Ann Surg. 2010;251(3):477–82.PubMedCrossRef
26.
Zurück zum Zitat Tanaka M, Fernandez-Del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12(3):183–97.PubMedCrossRef Tanaka M, Fernandez-Del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12(3):183–97.PubMedCrossRef
27.
Zurück zum Zitat Falconi M, Salvia R, Bassi C, et al. Clinicopathological features and treatment of intraductal papillary mucinous tumour of the pancreas. Br J Surg. 2001;88(3):376–81.PubMedCrossRef Falconi M, Salvia R, Bassi C, et al. Clinicopathological features and treatment of intraductal papillary mucinous tumour of the pancreas. Br J Surg. 2001;88(3):376–81.PubMedCrossRef
28.
Zurück zum Zitat Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an increasingly recognized clinicopathologic entity. Ann Surg. 2001;234(3):313–21 (Discussion 321–2). Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an increasingly recognized clinicopathologic entity. Ann Surg. 2001;234(3):313–21 (Discussion 321–2).
Metadaten
Titel
4th Austrian pancreas day: a summary of the surgical management of exocrine pancreatic neoplasms
verfasst von
K. Sahora
M. Schindl
M. Gnant
Publikationsdatum
01.10.2013
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 5/2013
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-013-0229-5

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