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Duodenumerhaltende totale Pankreaskopfresektion

Ein organsparendes Verfahren bei zystischen Neoplasien und nichtinvasiven malignen Tumoren

Duodenum-preserving total pancreatic head resection

An organ-sparing operation technique for cystic neoplasms and non-invasive malignant tumors

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Zusammenfassung

Zystische Neoplasien der Bauchspeicheldrüse werden zunehmend häufiger diagnostiziert und operiert. Intraduktale papilläre muzinöse Tumoren (IPMN) und muzinöse zystische Neoplasien (MCN) sind primär gutartige Tumoren, die eine maligne Transformation zum zystischen Adenokarzinom mit unterschiedlicher Häufigkeit durchlaufen. Die duodenumerhaltende totale Pankreaskopfresektion ist ein bei entzündlichen Pankreaskopftumoren zunehmend häufig angewandtes Operationsverfahren, das auch bei zystischen Neoplasien und nichtinvasiven Malignomen ein adäquates Therapieverfahren darstellt. Die totale Entfernung des Pankreaskopfes kann als eine das Duodenum vollständig erhaltende Operation oder mit zusätzlicher Segmentresektion des peripapillären Duodenums und des intrapankreatischen Ductus choledochus angewandt werden.

Eine Literaturrecherche ergab IPMN, MCN und SCA (seröse Zystadenome) -Tumoren als häufigste Operationsindikation; 9% der Patienten hatten ein In-situ-Karzinom; bei 74 (19%) Patienten erfolgte die Operation wegen eines T1N0-periampulären Karzinoms oder einer endokrinen Neoplasie oder wegen isolierter Pankreaskopfmetastase. 63% hatten eine duodenumerhaltende totale Pankreaskopfresektion (DPPHRt), bei 37% wurde auch das peripapilläre Segment des Duodenums reseziert. Früh-postoperative Komplikationen traten am Choledochus (10%), und am Duodenum (5,3%) auf; die Pankreasfistelhäufigkeit betrug 16,5%; die Reoperationshäufigkeit (1,8%) und Krankenhausletalität (0,52%) waren niedrig. Im Vergleich zur Whipple-Typ-Resektion vermindert die DPPHRt nicht die exokrinen und endokrinen Funktionen der Bauchspeicheldrüse.

Abstract

Cystic neoplasms of the pancreas are being detected and surgically treated increasingly more frequently. Intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN) are primary benign lesions; however, the 5-year risk for malignant transformation has been estimated to be 63 % and 15 %, respectively. Surgical extirpation of a benign cystic tumor of the pancreas is a cancer preventive measure. The duodenum-preserving total pancreatic head resection technique (DPPHRt) is being used more frequently for cystic neoplasms of the pancreatic head. The complete resection of the pancreatic head can be applied as a duodenum-preserving technique or with segmental resection of the peripapillary duodenum. Borderline lesions, carcinoma in situ or T1N0 cancer of the papilla and the peripapillary common bile duct are also considered to be indications for segmental resection of the peripapillary duodenum. A literature search for cystic neoplastic lesions and DPPHRt revealed the most frequent indications to be IPMN, MCN and SCA lesions and 28 % suffered from a cystic neoplasm with carcinoma in situ or a peripapillary malignoma. The hospital mortality rate was 0.52 %. Compared to the Whipple type resection the DPPHRt exhibits significant benefits with respect to a low risk for early postoperative complications and a low hospital mortality rate of < 1 %. Exocrine and endocrine pancreatic functions after DPPHR are not impaired compared to the Whipple type resection.

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Authors and Affiliations

  1. Zentrum für onkologische, endokrinologische und minimalinvasive Chirurgie, Donauklinikum Neu-Ulm, Ulm, Deutschland

    H.G. Beger & B. Poch

  2. Chirurgische Klinik I, Ostalb-Klinikum, Aalen, Deutschland

    M. Siech

  3. c/o Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland

    H.G. Beger

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  1. H.G. Beger
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  2. M. Siech
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Correspondence to H.G. Beger.

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Beger, H., Siech, M. & Poch, B. Duodenumerhaltende totale Pankreaskopfresektion. Chirurg 84, 412–420 (2013). https://doi.org/10.1007/s00104-012-2423-6

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