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Erschienen in: Wiener Medizinische Wochenschrift 3-4/2014

01.02.2014 | main topic

Clinical approach to the patient with a solid pancreatic mass

verfasst von: Prof. Dr. Reinhold Függer, Odo Gangl, Uwe Fröschl

Erschienen in: Wiener Medizinische Wochenschrift | Ausgabe 3-4/2014

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Summary

Diagnosis and clinical work-up of a solid pancreatic mass is a challenging problem. Patients’ history, laboratory parameters, computed tomography magnetic resonance imaging, and endosonography are the cornerstones in diagnosis. Biopsy is indicated in selected patients. The main goal of surgical indication is to select patients with suspected malignancy who are resectable, but avoid unnecessary resections. About 5 % of patients resected due to suspicion of malignancy finally present with a benign histology. Autoimmune pancreatitis is the most frequent cause of such unnecessary resections.
Literatur
1.
Zurück zum Zitat Carpelan-Holmström 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;54:385–7.PubMedCentralPubMedCrossRef Carpelan-Holmström 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;54:385–7.PubMedCentralPubMedCrossRef
2.
Zurück zum Zitat http://www.statistik.at/web_de/statistiken/gesundheit/krebserkrankungen/bauchspeicheldrüse/index.html. http://www.statistik.at/web_de/statistiken/gesundheit/krebserkrankungen/bauchspeicheldrüse/index.html.
3.
Zurück zum Zitat Birkmeyer JD, Siewers AD, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37.PubMedCrossRef Birkmeyer JD, Siewers AD, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37.PubMedCrossRef
5.
Zurück zum Zitat Conrad C, Fernandez-del Castillo C. Preoperative evaluation and management of the pancreatic head mass. J Surg Oncol. 2013;107:23–32.PubMedCrossRef Conrad C, Fernandez-del Castillo C. Preoperative evaluation and management of the pancreatic head mass. J Surg Oncol. 2013;107:23–32.PubMedCrossRef
6.
Zurück zum Zitat Steinberg W. The clinical utility of the CA 19-9 tumorassociated antigen. Am J Gastroenterol. 1990;85:350–5.PubMed Steinberg W. The clinical utility of the CA 19-9 tumorassociated antigen. Am J Gastroenterol. 1990;85:350–5.PubMed
7.
Zurück zum Zitat Bünger S, Laubert T, Roblick UJ, et al. Serum biomarkers for improved diagnostic of pancreatic cancer: a current overview. J Cancer Res Clin Oncol. 2011;137:375–89.PubMedCrossRef Bünger S, Laubert T, Roblick UJ, et al. Serum biomarkers for improved diagnostic of pancreatic cancer: a current overview. J Cancer Res Clin Oncol. 2011;137:375–89.PubMedCrossRef
8.
Zurück zum Zitat Fritz S, Hackert T, Hinz U, et al. Role of serum carbohydrate antigen 19-9 and carcinoembryonic antigen in distinguishing between benign and invasive intraducatal papillary mucinous neoplasm of the pancreas. Br J Surg. 2011;98:104–10.PubMedCrossRef Fritz S, Hackert T, Hinz U, et al. Role of serum carbohydrate antigen 19-9 and carcinoembryonic antigen in distinguishing between benign and invasive intraducatal papillary mucinous neoplasm of the pancreas. Br J Surg. 2011;98:104–10.PubMedCrossRef
9.
Zurück zum Zitat Zatelli MC, Torta M, Leon A, et al. Chromogranin A as a marker of neuroendocrine neoplasia: an Italian multicenter study. Endocr Relat Cancer. 2007;14:473–82.PubMedCrossRef Zatelli MC, Torta M, Leon A, et al. Chromogranin A as a marker of neuroendocrine neoplasia: an Italian multicenter study. Endocr Relat Cancer. 2007;14:473–82.PubMedCrossRef
10.
Zurück zum Zitat Smith SL, Rajan PS. Imaging of pancreatic adenocarcinoma with emphasis on multidetector CT. Clin Radiol. 2004;59:26–38.PubMedCrossRef Smith SL, Rajan PS. Imaging of pancreatic adenocarcinoma with emphasis on multidetector CT. Clin Radiol. 2004;59:26–38.PubMedCrossRef
11.
Zurück zum Zitat Schueller G, Schima W, Schueller-Weidekamm C, et al. Multidetector CT of pancreas: effects of contrast material flow rate and individualized scan delay on enhancement of pancreas and tumor contrast. Radiology. 2006;241:441–8.PubMedCrossRef Schueller G, Schima W, Schueller-Weidekamm C, et al. Multidetector CT of pancreas: effects of contrast material flow rate and individualized scan delay on enhancement of pancreas and tumor contrast. Radiology. 2006;241:441–8.PubMedCrossRef
13.
Zurück zum Zitat Scheithauer K, Miederer M, Gaertner FC. PET-CT bei neuroendokrinen Tumoren und nuklearmedizinische Therapiemöglichkeiten. Radiologe. 2009;49:217–23.CrossRef Scheithauer K, Miederer M, Gaertner FC. PET-CT bei neuroendokrinen Tumoren und nuklearmedizinische Therapiemöglichkeiten. Radiologe. 2009;49:217–23.CrossRef
14.
Zurück zum Zitat Helmstaedter L, Riemann JF. Pancreatic cancer—EUS and early diagnosis. Langenbecks Arch Surg. 2008;393:923–7.PubMedCrossRef Helmstaedter L, Riemann JF. Pancreatic cancer—EUS and early diagnosis. Langenbecks Arch Surg. 2008;393:923–7.PubMedCrossRef
15.
Zurück zum Zitat Rösch T, Braig C, Gain T, et al. Staging of pancreatic and ampullary carcinoma by endoscopic ultrasonography. Comparison with conventionalsonography, computed tomography, and angiography. Gastroenterology. 1992;102:188–99.PubMed Rösch T, Braig C, Gain T, et al. Staging of pancreatic and ampullary carcinoma by endoscopic ultrasonography. Comparison with conventionalsonography, computed tomography, and angiography. Gastroenterology. 1992;102:188–99.PubMed
16.
Zurück zum Zitat Schöfl R. Pancreatic carcinoma—diagnosis and screening—endoscopic therapy. Wien Klin Wochenschr. 1994;106:698–700.PubMed Schöfl R. Pancreatic carcinoma—diagnosis and screening—endoscopic therapy. Wien Klin Wochenschr. 1994;106:698–700.PubMed
17.
Zurück zum Zitat Lermite E, Pessaux P, Teyssedou C, et al. Effect of preoperative endoscopic biliary drainage on infectious morbidity after pancreatoduodenectomy: a case-control study. Am J Surg. 2008;195:442–6.PubMedCrossRef Lermite E, Pessaux P, Teyssedou C, et al. Effect of preoperative endoscopic biliary drainage on infectious morbidity after pancreatoduodenectomy: a case-control study. Am J Surg. 2008;195:442–6.PubMedCrossRef
18.
Zurück zum Zitat Mezhir JJ, Brennan MF, Baser RE, et al. A matched case-control study of preoperative biliary drainage in patients with pancreatic adenocarcinoma: routine drainage is not justified. J Gastrointest Surg. 2009;13:2163–9.PubMedCrossRef Mezhir JJ, Brennan MF, Baser RE, et al. A matched case-control study of preoperative biliary drainage in patients with pancreatic adenocarcinoma: routine drainage is not justified. J Gastrointest Surg. 2009;13:2163–9.PubMedCrossRef
19.
Zurück zum Zitat Mizuno T, Ishizaki Y, Komuro Y, et al. Surgical treatment of abdominal wall tumor seeding after percutaneous transhepatic biliary drainage. Am J Surg. 2007;193:511–3.PubMedCrossRef Mizuno T, Ishizaki Y, Komuro Y, et al. Surgical treatment of abdominal wall tumor seeding after percutaneous transhepatic biliary drainage. Am J Surg. 2007;193:511–3.PubMedCrossRef
20.
Zurück zum Zitat Bonin EA, Baron TH. Preoperative biliary stents in pancreatic cancer. J Hepatobiliary Pancreat Sci. 2011;18:621–9.PubMedCrossRef Bonin EA, Baron TH. Preoperative biliary stents in pancreatic cancer. J Hepatobiliary Pancreat Sci. 2011;18:621–9.PubMedCrossRef
21.
Zurück zum Zitat Beger HG, Birk D, Bodner E, et al. Is histological verification of pancreatic carcinoma a prerequisite for pancreatic resection? Langenbecks Arch Surg. 1995;380:62–6. Beger HG, Birk D, Bodner E, et al. Is histological verification of pancreatic carcinoma a prerequisite for pancreatic resection? Langenbecks Arch Surg. 1995;380:62–6.
22.
Zurück zum Zitat Hartwig W, Schneider L, Diener MK, et al. Preoperative tissue diagnosis for tumours of the pancreas. Br J Surg. 2009;96:5–20.PubMedCrossRef Hartwig W, Schneider L, Diener MK, et al. Preoperative tissue diagnosis for tumours of the pancreas. Br J Surg. 2009;96:5–20.PubMedCrossRef
23.
Zurück zum Zitat Yun SS, Remotti H, Vazquez MF, et al. Endoscopic ultrasound-guided biopsies of pancreatic masses: comparison between fine needle aspirations and needle core biopsies. Diagn Cytopathol. 2007;35:276–82.PubMedCrossRef Yun SS, Remotti H, Vazquez MF, et al. Endoscopic ultrasound-guided biopsies of pancreatic masses: comparison between fine needle aspirations and needle core biopsies. Diagn Cytopathol. 2007;35:276–82.PubMedCrossRef
24.
Zurück zum Zitat Aithal GP, Anagnostopoulos GK, Tam W, et al. EUS-guided tissue sampling: comparison of dual sampling with sequential sampling. Endoscopy. 2007;39:725–30.PubMedCrossRef Aithal GP, Anagnostopoulos GK, Tam W, et al. EUS-guided tissue sampling: comparison of dual sampling with sequential sampling. Endoscopy. 2007;39:725–30.PubMedCrossRef
25.
Zurück zum Zitat Binmoeller KF, Thul R, Rathod V, et al. Endoscopic ultrasound-guided, 18-gauge, fine needle aspiration biopsy of the pancreas using a 2.8 mm channel convex array echoendoscope. Gastrointest Endosc. 1998;47:121–7.PubMedCrossRef Binmoeller KF, Thul R, Rathod V, et al. Endoscopic ultrasound-guided, 18-gauge, fine needle aspiration biopsy of the pancreas using a 2.8 mm channel convex array echoendoscope. Gastrointest Endosc. 1998;47:121–7.PubMedCrossRef
26.
Zurück zum Zitat Eloubeidi MA, Varadarajulu S, Desai S, et al. A prospective evaluation of an algorithm incorporating routine preoperative endoscopic ultrasound-guided fine needle aspiration in suspected pancreatic cancer. J Gastrointest Surg. 2007;11:813–9.PubMedCrossRef Eloubeidi MA, Varadarajulu S, Desai S, et al. A prospective evaluation of an algorithm incorporating routine preoperative endoscopic ultrasound-guided fine needle aspiration in suspected pancreatic cancer. J Gastrointest Surg. 2007;11:813–9.PubMedCrossRef
27.
Zurück zum Zitat Krishna NB, Tummala P, Mehan CD, et al. Small and potentiall resectable focal pancreatic lesions noted on CT/MRI scans in nonjaundiced patients: likelihood of neoplasia and utility of EUS. J Gastrointest Surg. 2012;16:793–800.PubMedCrossRef Krishna NB, Tummala P, Mehan CD, et al. Small and potentiall resectable focal pancreatic lesions noted on CT/MRI scans in nonjaundiced patients: likelihood of neoplasia and utility of EUS. J Gastrointest Surg. 2012;16:793–800.PubMedCrossRef
28.
Zurück zum Zitat Meining A, Rösch T, Wolf A, et al. High interobserver variability in endosonographic staging of upper gastrointestinal cancers. Z Gastroenterol. 2003:41:391–4.PubMedCrossRef Meining A, Rösch T, Wolf A, et al. High interobserver variability in endosonographic staging of upper gastrointestinal cancers. Z Gastroenterol. 2003:41:391–4.PubMedCrossRef
29.
Zurück zum Zitat Gleeson FC, Kipp BR, Caudill JL, et al. False positive endoscopic ultrasound fine needle aspiration cytology: incidence and risk factors. Gut. 2010;59:586–93.PubMedCrossRef Gleeson FC, Kipp BR, Caudill JL, et al. False positive endoscopic ultrasound fine needle aspiration cytology: incidence and risk factors. Gut. 2010;59:586–93.PubMedCrossRef
30.
Zurück zum Zitat Targarona EM, Pera M, Martinez J, et al. Laparoscopic treatment of pancreatic disorders: diagnosis and staging, palliation of cancer and treatment of pancreatic pseudocysts. Int Surg. 1996;81:1–5.PubMed Targarona EM, Pera M, Martinez J, et al. Laparoscopic treatment of pancreatic disorders: diagnosis and staging, palliation of cancer and treatment of pancreatic pseudocysts. Int Surg. 1996;81:1–5.PubMed
31.
Zurück zum Zitat Minnard EA, Conlon KC, Hoos A, et al. Laparoscopic ultrasound enhances standard laparoscopy in the staging of pancreatic cancer. Ann Surg. 1998;228:182–7.PubMedCentralPubMedCrossRef Minnard EA, Conlon KC, Hoos A, et al. Laparoscopic ultrasound enhances standard laparoscopy in the staging of pancreatic cancer. Ann Surg. 1998;228:182–7.PubMedCentralPubMedCrossRef
32.
Zurück zum Zitat Tapper E, Kalb B, Martin Dr, et al. Staging laparoscopy for proximal pancreatic cancer in a magnetic resonance imaging-driven practice: what’s it worth? HPB (Oxford). 2011;13:732–7.PubMedCentralPubMedCrossRef Tapper E, Kalb B, Martin Dr, et al. Staging laparoscopy for proximal pancreatic cancer in a magnetic resonance imaging-driven practice: what’s it worth? HPB (Oxford). 2011;13:732–7.PubMedCentralPubMedCrossRef
33.
Zurück zum Zitat Königsrainer I, Zieker D, Symons S, et al. Do patient- and tumor-related factors predict the peritoneal spread of pancreatic adenocarcinoma? Surg Today. 2014;44:260–3. Königsrainer I, Zieker D, Symons S, et al. Do patient- and tumor-related factors predict the peritoneal spread of pancreatic adenocarcinoma? Surg Today. 2014;44:260–3.
34.
Zurück zum Zitat van Gulik TM, Reeders JW, Bosma A, et al. Incidence and clinical findings of benign, inflammatory disease in patients resected for presumed pancreatic head cancer. Gastrointest Endosc. 1997;46:417–23.PubMedCrossRef van Gulik TM, Reeders JW, Bosma A, et al. Incidence and clinical findings of benign, inflammatory disease in patients resected for presumed pancreatic head cancer. Gastrointest Endosc. 1997;46:417–23.PubMedCrossRef
35.
Zurück zum Zitat Smith CD, Behrns KE, van Heerden JA, et al. Radical pancreatoduodenectomy for misdiagnosed pancreatic mass. Br J Surg 1994;81:585–9.PubMedCrossRef Smith CD, Behrns KE, van Heerden JA, et al. Radical pancreatoduodenectomy for misdiagnosed pancreatic mass. Br J Surg 1994;81:585–9.PubMedCrossRef
36.
Zurück zum Zitat Abraham SC, Wilentz RE, Yeo CJ, et al. Pancreaticoduodenectomy (Whipple resections) in patients without malignancy. Am J Surg Pathol. 2003;27:110–20.PubMedCrossRef Abraham SC, Wilentz RE, Yeo CJ, et al. Pancreaticoduodenectomy (Whipple resections) in patients without malignancy. Am J Surg Pathol. 2003;27:110–20.PubMedCrossRef
37.
Zurück zum Zitat Gangl O, Fröschl U, Hofer W, et al. Unplanned reoperation and reintervention after pancreatic resections: an analysis of risk factors. World J Surg. 2011;35:2306–14.PubMedCrossRef Gangl O, Fröschl U, Hofer W, et al. Unplanned reoperation and reintervention after pancreatic resections: an analysis of risk factors. World J Surg. 2011;35:2306–14.PubMedCrossRef
38.
Zurück zum Zitat Winter JM, Brennan MF, Tang LH, et al. Survival after resection of pancreatic adenocarcinoma: results from a single institution over three decades. Ann Surg Oncol. 2012;19:169–75.PubMedCrossRef Winter JM, Brennan MF, Tang LH, et al. Survival after resection of pancreatic adenocarcinoma: results from a single institution over three decades. Ann Surg Oncol. 2012;19:169–75.PubMedCrossRef
39.
Zurück zum Zitat Gangl O, Sahora K, Kornprat P, et al. Preparing for prospective clinical trials: a National Initiative of an Excellency Registry for Consecutive Pancreatic Cancer Resections. World J Surg. 2013. Epub ahead of print. Gangl O, Sahora K, Kornprat P, et al. Preparing for prospective clinical trials: a National Initiative of an Excellency Registry for Consecutive Pancreatic Cancer Resections. World J Surg. 2013. Epub ahead of print.
40.
Zurück zum Zitat Jensen RT, Cadiot G, Brandi ML, et al. ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms: functional pancreatic endocrine tumor syndromes. Neuroendocrinology. 2012;95:98–119. Jensen RT, Cadiot G, Brandi ML, et al. ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms: functional pancreatic endocrine tumor syndromes. Neuroendocrinology. 2012;95:98–119.
41.
Zurück zum Zitat Falconi M, Bartsch DK, Eriksson B, et al. ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms of the digestive system: well-differentiated pancreatic non-functioning tumors. Neuroendocrinology. 2012;95:120–34.PubMedCrossRef Falconi M, Bartsch DK, Eriksson B, et al. ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms of the digestive system: well-differentiated pancreatic non-functioning tumors. Neuroendocrinology. 2012;95:120–34.PubMedCrossRef
42.
Zurück zum Zitat Pavel M, Baudin E, Couvelard A, et al. ENETS consensus guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut and unknown primary. Neuroendocrinology. 2012;95:157–76. Pavel M, Baudin E, Couvelard A, et al. ENETS consensus guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut and unknown primary. Neuroendocrinology. 2012;95:157–76.
Metadaten
Titel
Clinical approach to the patient with a solid pancreatic mass
verfasst von
Prof. Dr. Reinhold Függer
Odo Gangl
Uwe Fröschl
Publikationsdatum
01.02.2014
Verlag
Springer Vienna
Erschienen in
Wiener Medizinische Wochenschrift / Ausgabe 3-4/2014
Print ISSN: 0043-5341
Elektronische ISSN: 1563-258X
DOI
https://doi.org/10.1007/s10354-014-0266-0

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