Skip to main content
Erschienen in: Die Chirurgie 5/2022

31.03.2022 | Pankreaskarzinom | Leitthema

Chirurgische Therapie des Pankreaskarzinoms – was gibt es Neues?

verfasst von: Univ.-Prof. Dr. Dr. med. Thomas Schmidt, Orlin Belyaev, Waldemar Uhl, Christiane J. Bruns

Erschienen in: Die Chirurgie | Ausgabe 5/2022

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die Inzidenz des duktalen Adenokarzinoms des Pankreas steigt weiterhin und es wird bis 2030 zur zweithäufigsten krebsbedingten Todesursache in Europa und den USA aufsteigen. Mit einer 5‑Jahres-Überlebensrate von nur bis zu 10 % hat es weiterhin eine sehr schlechte Prognose. Die chirurgische Tumorresektion stellt die einzige kurative Therapieoption dar, die inzwischen zum Teil durch multimodale neoadjuvante und adjuvante Therapiekonzepte unterstützt wird. Aufgrund der aggressiven Tumorbiologie können Patienten insbesondere bei fortgeschrittenen Pankreaskarzinomen von diesen multimodalen Therapiekonzepten profitieren. Daneben wurden in den letzten Jahren die chirurgische Therapie optimiert, die Resektabilität anhand verschiedener Kriterien klarer definiert und minimal-invasive Operationen in der Breite eingeführt. Die aktuelle Übersichtsarbeit fasst die neuesten Entwicklungen und die neue S3-Leitlinie zum Thema Chirurgie beim Pankreaskarzinom zusammen.
Literatur
1.
Zurück zum Zitat Ducreux M et al (2015) Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 26(Suppl 5):v56–v68PubMedCrossRef Ducreux M et al (2015) Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 26(Suppl 5):v56–v68PubMedCrossRef
3.
Zurück zum Zitat Rahib L et al (2014) Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res 74(11):2913–2921PubMedCrossRef Rahib L et al (2014) Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res 74(11):2913–2921PubMedCrossRef
5.
Zurück zum Zitat Takaori K et al (2016) International Association of Pancreatology (IAP)/European Pancreatic Club (EPC) consensus review of guidelines for the treatment of pancreatic cancer. Pancreatology 16(1):14–27PubMedCrossRef Takaori K et al (2016) International Association of Pancreatology (IAP)/European Pancreatic Club (EPC) consensus review of guidelines for the treatment of pancreatic cancer. Pancreatology 16(1):14–27PubMedCrossRef
6.
Zurück zum Zitat Hank T et al (2018) Validation of at least 1 mm as cut-off for resection margins for pancreatic adenocarcinoma of the body and tail. Br J Surg 105(9):1171–1181PubMedCrossRef Hank T et al (2018) Validation of at least 1 mm as cut-off for resection margins for pancreatic adenocarcinoma of the body and tail. Br J Surg 105(9):1171–1181PubMedCrossRef
7.
Zurück zum Zitat Strobel O et al (2017) Pancreatic cancer surgery: the new R‑status counts. Ann Surg 265(3):565–573PubMedCrossRef Strobel O et al (2017) Pancreatic cancer surgery: the new R‑status counts. Ann Surg 265(3):565–573PubMedCrossRef
8.
Zurück zum Zitat Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, D.K., AWMF), S3-Leitlinie zum exokrinen Pankreaskarzinom, Langversion 2.0, 2021, AWMF Registernummer: 032-010OL. 2021. Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, D.K., AWMF), S3-Leitlinie zum exokrinen Pankreaskarzinom, Langversion 2.0, 2021, AWMF Registernummer: 032-010OL. 2021.
9.
Zurück zum Zitat Isaji S et al (2018) International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. Pancreatology 18(1):2–11PubMedCrossRef Isaji S et al (2018) International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. Pancreatology 18(1):2–11PubMedCrossRef
10.
Zurück zum Zitat Persigehl T et al (2020) Structured reporting of solid and cystic pancreatic lesions in CT and MRI: consensus-based structured report templates of the German Society of Radiology (DRG). Rofo 192(7):641–656PubMedCrossRef Persigehl T et al (2020) Structured reporting of solid and cystic pancreatic lesions in CT and MRI: consensus-based structured report templates of the German Society of Radiology (DRG). Rofo 192(7):641–656PubMedCrossRef
11.
Zurück zum Zitat Wittel UA et al (2019) Consensus in determining the resectability of locally progressed pancreatic ductal adenocarcinoma—results of the Conko-007 multicenter trial. BMC Cancer 19(1):979PubMedPubMedCentralCrossRef Wittel UA et al (2019) Consensus in determining the resectability of locally progressed pancreatic ductal adenocarcinoma—results of the Conko-007 multicenter trial. BMC Cancer 19(1):979PubMedPubMedCentralCrossRef
12.
Zurück zum Zitat Jang JK et al (2021) CT-determined resectability of borderline resectable and unresectable pancreatic adenocarcinoma following FOLFIRINOX therapy. Eur Radiol 31(2):813–823PubMedCrossRef Jang JK et al (2021) CT-determined resectability of borderline resectable and unresectable pancreatic adenocarcinoma following FOLFIRINOX therapy. Eur Radiol 31(2):813–823PubMedCrossRef
13.
Zurück zum Zitat Marchegiani G et al (2018) Surgery after FOLFIRINOX treatment for locally advanced and borderline resectable pancreatic cancer: increase in tumour attenuation on CT correlates with R0 resection. Eur Radiol 28(10):4265–4273PubMedCrossRef Marchegiani G et al (2018) Surgery after FOLFIRINOX treatment for locally advanced and borderline resectable pancreatic cancer: increase in tumour attenuation on CT correlates with R0 resection. Eur Radiol 28(10):4265–4273PubMedCrossRef
14.
Zurück zum Zitat Jeon SK et al (2022) How to approach pancreatic cancer after neoadjuvant treatment: assessment of resectability using multidetector CT and tumor markers. Eur Radiol 32(1):56–66PubMedCrossRef Jeon SK et al (2022) How to approach pancreatic cancer after neoadjuvant treatment: assessment of resectability using multidetector CT and tumor markers. Eur Radiol 32(1):56–66PubMedCrossRef
15.
Zurück zum Zitat Hartwig W et al (2013) CA19‑9 in potentially resectable pancreatic cancer: perspective to adjust surgical and perioperative therapy. Ann Surg Oncol 20(7):2188–2196PubMedCrossRef Hartwig W et al (2013) CA19‑9 in potentially resectable pancreatic cancer: perspective to adjust surgical and perioperative therapy. Ann Surg Oncol 20(7):2188–2196PubMedCrossRef
16.
Zurück zum Zitat Negoi I et al (2018) Surgical anatomy of the superior mesenteric vessels related to pancreaticoduodenectomy: a systematic review and meta-analysis. J Gastrointest Surg 22(5):802–817PubMedCrossRef Negoi I et al (2018) Surgical anatomy of the superior mesenteric vessels related to pancreaticoduodenectomy: a systematic review and meta-analysis. J Gastrointest Surg 22(5):802–817PubMedCrossRef
17.
Zurück zum Zitat Hackert T et al (2017) The TRIANGLE operation—radical surgery after neoadjuvant treatment for advanced pancreatic cancer: a single arm observational study. HPB 19(11):1001–1007PubMedCrossRef Hackert T et al (2017) The TRIANGLE operation—radical surgery after neoadjuvant treatment for advanced pancreatic cancer: a single arm observational study. HPB 19(11):1001–1007PubMedCrossRef
18.
Zurück zum Zitat Schneider M et al (2019) Pancreatic resection for cancer-the Heidelberg technique. Langenbecks Arch Surg 404(8):1017–1022PubMedCrossRef Schneider M et al (2019) Pancreatic resection for cancer-the Heidelberg technique. Langenbecks Arch Surg 404(8):1017–1022PubMedCrossRef
19.
Zurück zum Zitat Mitchem JB et al (2012) Long-term results of resection of adenocarcinoma of the body and tail of the pancreas using radical antegrade modular pancreatosplenectomy procedure. J Am Coll Surg 214(1):46–52PubMedCrossRef Mitchem JB et al (2012) Long-term results of resection of adenocarcinoma of the body and tail of the pancreas using radical antegrade modular pancreatosplenectomy procedure. J Am Coll Surg 214(1):46–52PubMedCrossRef
20.
Zurück zum Zitat Zhou Q et al (2019) Assessement of postoperative long-term survival quality and complications associated with radical antegrade modular pancreatosplenectomy and distal pancreatectomy: a meta-analysis and systematic review. BMC Surg 19(1):12PubMedPubMedCentralCrossRef Zhou Q et al (2019) Assessement of postoperative long-term survival quality and complications associated with radical antegrade modular pancreatosplenectomy and distal pancreatectomy: a meta-analysis and systematic review. BMC Surg 19(1):12PubMedPubMedCentralCrossRef
21.
Zurück zum Zitat Schmidt T et al (2020) Cavernous transformation of the portal vein in pancreatic cancer surgery-venous bypass graft first. Langenbecks Arch Surg 405(7):1045–1050PubMedPubMedCentralCrossRef Schmidt T et al (2020) Cavernous transformation of the portal vein in pancreatic cancer surgery-venous bypass graft first. Langenbecks Arch Surg 405(7):1045–1050PubMedPubMedCentralCrossRef
22.
Zurück zum Zitat Mihaljevic AL et al (2021) Not all Whipple procedures are equal: proposal for a classification of pancreatoduodenectomies. Surgery 169(6):1456–1462PubMedCrossRef Mihaljevic AL et al (2021) Not all Whipple procedures are equal: proposal for a classification of pancreatoduodenectomies. Surgery 169(6):1456–1462PubMedCrossRef
24.
Zurück zum Zitat Malczak P et al (2020) Arterial resections in pancreatic cancer—Systematic review and meta-analysis. HPB 22(7):961–968PubMedCrossRef Malczak P et al (2020) Arterial resections in pancreatic cancer—Systematic review and meta-analysis. HPB 22(7):961–968PubMedCrossRef
25.
Zurück zum Zitat Ironside N et al (2018) Meta-analysis of an artery-first approach versus standard pancreatoduodenectomy on perioperative outcomes and survival. Br J Surg 105(6):628–636PubMedCrossRef Ironside N et al (2018) Meta-analysis of an artery-first approach versus standard pancreatoduodenectomy on perioperative outcomes and survival. Br J Surg 105(6):628–636PubMedCrossRef
27.
Zurück zum Zitat Diener MK et al (2021) Periarterial divestment in pancreatic cancer surgery. Surgery 169(5):1019–1025PubMedCrossRef Diener MK et al (2021) Periarterial divestment in pancreatic cancer surgery. Surgery 169(5):1019–1025PubMedCrossRef
28.
Zurück zum Zitat Cai B et al (2021) Sub-adventitial divestment technique for resecting artery-involved pancreatic cancer: a retrospective cohort study. Langenbecks Arch Surg 406(3):691–701PubMedCrossRef Cai B et al (2021) Sub-adventitial divestment technique for resecting artery-involved pancreatic cancer: a retrospective cohort study. Langenbecks Arch Surg 406(3):691–701PubMedCrossRef
29.
30.
Zurück zum Zitat Crippa S et al (2020) A systematic review of surgical resection of liver-only synchronous metastases from pancreatic cancer in the era of multiagent chemotherapy. Updates Surg 72(1):39–45PubMedCrossRef Crippa S et al (2020) A systematic review of surgical resection of liver-only synchronous metastases from pancreatic cancer in the era of multiagent chemotherapy. Updates Surg 72(1):39–45PubMedCrossRef
31.
Zurück zum Zitat Hackert T et al (2017) Radical surgery of oligometastatic pancreatic cancer. Eur J Surg Oncol 43(2):358–363PubMedCrossRef Hackert T et al (2017) Radical surgery of oligometastatic pancreatic cancer. Eur J Surg Oncol 43(2):358–363PubMedCrossRef
33.
Zurück zum Zitat Gebauer F et al (2021) Study protocol of an open-label, single arm phase II trial investigating the efficacy, safety and quality of life of neoadjuvant chemotherapy with liposomal irinotecan combined with Oxaliplatin and 5‑fluorouracil/Folinic acid followed by curative surgical resection in patients with hepatic Oligometastatic adenocarcinoma of the pancreas (HOLIPANC). BMC Cancer 21(1):1239PubMedPubMedCentralCrossRef Gebauer F et al (2021) Study protocol of an open-label, single arm phase II trial investigating the efficacy, safety and quality of life of neoadjuvant chemotherapy with liposomal irinotecan combined with Oxaliplatin and 5‑fluorouracil/Folinic acid followed by curative surgical resection in patients with hepatic Oligometastatic adenocarcinoma of the pancreas (HOLIPANC). BMC Cancer 21(1):1239PubMedPubMedCentralCrossRef
34.
Zurück zum Zitat Crippa S et al (2020) Positive neck margin at frozen section analysis is a significant predictor of tumour recurrence and poor survival after pancreatodudenectomy for pancreatic cancer. Eur J Surg Oncol 46(8):1524–1531PubMedCrossRef Crippa S et al (2020) Positive neck margin at frozen section analysis is a significant predictor of tumour recurrence and poor survival after pancreatodudenectomy for pancreatic cancer. Eur J Surg Oncol 46(8):1524–1531PubMedCrossRef
35.
Zurück zum Zitat Zhang B et al (2021) Revision of pancreatic neck margins based on intraoperative frozen section analysis is associated with improved survival in patients undergoing Pancreatectomy for ductal Adenocarcinoma. Ann Surg 274(2):e134–e142PubMedCrossRef Zhang B et al (2021) Revision of pancreatic neck margins based on intraoperative frozen section analysis is associated with improved survival in patients undergoing Pancreatectomy for ductal Adenocarcinoma. Ann Surg 274(2):e134–e142PubMedCrossRef
36.
Zurück zum Zitat Nitschke P et al (2017) Impact of Intraoperative re-resection to achieve R0 status on survival in patients with pancreatic cancer: a single-center experience with 483 patients. Ann Surg 265(6):1219–1225PubMedCrossRef Nitschke P et al (2017) Impact of Intraoperative re-resection to achieve R0 status on survival in patients with pancreatic cancer: a single-center experience with 483 patients. Ann Surg 265(6):1219–1225PubMedCrossRef
37.
Zurück zum Zitat Crippa S et al (2021) Improved survival after pancreatic re-resection of positive neck margin in pancreatic cancer patients. A systematic review and network meta-analysis. Eur J Surg Oncol 47(6):1258–1266PubMedCrossRef Crippa S et al (2021) Improved survival after pancreatic re-resection of positive neck margin in pancreatic cancer patients. A systematic review and network meta-analysis. Eur J Surg Oncol 47(6):1258–1266PubMedCrossRef
38.
Zurück zum Zitat Versteijne E et al (2018) Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer. Br J Surg 105(8):946–958PubMedPubMedCentralCrossRef Versteijne E et al (2018) Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer. Br J Surg 105(8):946–958PubMedPubMedCentralCrossRef
39.
Zurück zum Zitat Versteijne E et al (2020) Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: results of the Dutch randomized phase III PREOPANC trial. J Clin Oncol 38(16):1763–1773PubMedPubMedCentralCrossRef Versteijne E et al (2020) Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: results of the Dutch randomized phase III PREOPANC trial. J Clin Oncol 38(16):1763–1773PubMedPubMedCentralCrossRef
40.
Zurück zum Zitat Jang JY et al (2018) Oncological benefits of neoadjuvant chemoradiation with gemcitabine versus upfront surgery in patients with borderline resectable pancreatic cancer: a prospective, randomized, open-label, multicenter phase 2/3 trial. Ann Surg 268(2):215–222PubMedCrossRef Jang JY et al (2018) Oncological benefits of neoadjuvant chemoradiation with gemcitabine versus upfront surgery in patients with borderline resectable pancreatic cancer: a prospective, randomized, open-label, multicenter phase 2/3 trial. Ann Surg 268(2):215–222PubMedCrossRef
41.
Zurück zum Zitat Birrer DL et al (2021) Neoadjuvant therapy for Resectable pancreatic cancer: a new standard of care. Pooled data from 3 randomized controlled trials. Ann Surg 274(5):713–720PubMedCrossRef Birrer DL et al (2021) Neoadjuvant therapy for Resectable pancreatic cancer: a new standard of care. Pooled data from 3 randomized controlled trials. Ann Surg 274(5):713–720PubMedCrossRef
42.
Zurück zum Zitat van Dam JL et al (2022) Neoadjuvant therapy or upfront surgery for resectable and borderline resectable pancreatic cancer: a meta-analysis of randomised controlled trials. Eur J Cancer 160:140–149PubMedCrossRef van Dam JL et al (2022) Neoadjuvant therapy or upfront surgery for resectable and borderline resectable pancreatic cancer: a meta-analysis of randomised controlled trials. Eur J Cancer 160:140–149PubMedCrossRef
43.
Zurück zum Zitat Ferrone CR et al (2015) Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann Surg 261(1):12–17PubMedCrossRef Ferrone CR et al (2015) Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann Surg 261(1):12–17PubMedCrossRef
44.
Zurück zum Zitat Kunzmann V et al (2021) Nab-paclitaxel plus gemcitabine versus nab-paclitaxel plus gemcitabine followed by FOLFIRINOX induction chemotherapy in locally advanced pancreatic cancer (NEOLAP-AIO-PAK-0113): a multicentre, randomised, phase 2 trial. Lancet Gastroenterol Hepatol 6(2):128–138PubMedCrossRef Kunzmann V et al (2021) Nab-paclitaxel plus gemcitabine versus nab-paclitaxel plus gemcitabine followed by FOLFIRINOX induction chemotherapy in locally advanced pancreatic cancer (NEOLAP-AIO-PAK-0113): a multicentre, randomised, phase 2 trial. Lancet Gastroenterol Hepatol 6(2):128–138PubMedCrossRef
45.
Zurück zum Zitat Suker M et al (2016) FOLFIRINOX for locally advanced pancreatic cancer: a systematic review and patient-level meta-analysis. Lancet Oncol 17(6):801–810PubMedPubMedCentralCrossRef Suker M et al (2016) FOLFIRINOX for locally advanced pancreatic cancer: a systematic review and patient-level meta-analysis. Lancet Oncol 17(6):801–810PubMedPubMedCentralCrossRef
46.
Zurück zum Zitat Tsai S et al (2020) Importance of normalization of CA19‑9 levels following neoadjuvant therapy in patients with localized pancreatic cancer. Ann Surg 271(4):740–747PubMedCrossRef Tsai S et al (2020) Importance of normalization of CA19‑9 levels following neoadjuvant therapy in patients with localized pancreatic cancer. Ann Surg 271(4):740–747PubMedCrossRef
47.
Zurück zum Zitat Heger U et al (2020) Induction chemotherapy in pancreatic cancer: CA 19‑9 may predict resectability and survival. HPB 22(2):224–232PubMedCrossRef Heger U et al (2020) Induction chemotherapy in pancreatic cancer: CA 19‑9 may predict resectability and survival. HPB 22(2):224–232PubMedCrossRef
48.
Zurück zum Zitat de Rooij T et al (2019) Minimally invasive versus open distal pancreatectomy (LEOPARD): a multicenter patient-blinded randomized controlled trial. Ann Surg 269(1):2–9PubMedCrossRef de Rooij T et al (2019) Minimally invasive versus open distal pancreatectomy (LEOPARD): a multicenter patient-blinded randomized controlled trial. Ann Surg 269(1):2–9PubMedCrossRef
49.
Zurück zum Zitat Korrel M et al (2021) Minimally invasive versus open distal pancreatectomy: an individual patient data meta-analysis of two randomized controlled trials. HPB 23(3):323–330PubMedCrossRef Korrel M et al (2021) Minimally invasive versus open distal pancreatectomy: an individual patient data meta-analysis of two randomized controlled trials. HPB 23(3):323–330PubMedCrossRef
50.
Zurück zum Zitat Korrel M et al (2021) Long-term quality of life after minimally invasive vs open distal pancreatectomy in the LEOPARD randomized trial. J Am Coll Surg 233(6):730–739PubMedCrossRef Korrel M et al (2021) Long-term quality of life after minimally invasive vs open distal pancreatectomy in the LEOPARD randomized trial. J Am Coll Surg 233(6):730–739PubMedCrossRef
51.
Zurück zum Zitat van Hilst J et al (2019) Oncologic outcomes of minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a systematic review and meta-analysis. Eur J Surg Oncol 45(5):719–727PubMedCrossRef van Hilst J et al (2019) Oncologic outcomes of minimally invasive versus open distal pancreatectomy for pancreatic ductal adenocarcinoma: a systematic review and meta-analysis. Eur J Surg Oncol 45(5):719–727PubMedCrossRef
52.
Zurück zum Zitat van Hilst J et al (2019) Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): a pan-European propensity score matched study. Ann Surg 269(1):10–17PubMedCrossRef van Hilst J et al (2019) Minimally invasive versus open distal pancreatectomy for ductal adenocarcinoma (DIPLOMA): a pan-European propensity score matched study. Ann Surg 269(1):10–17PubMedCrossRef
53.
Zurück zum Zitat van Hilst J et al (2019) Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial. Lancet Gastroenterol Hepatol 4(3):199–207PubMedCrossRef van Hilst J et al (2019) Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial. Lancet Gastroenterol Hepatol 4(3):199–207PubMedCrossRef
54.
Zurück zum Zitat Wang M et al (2021) Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours: a multicentre, open-label, randomised controlled trial. Lancet Gastroenterol Hepatol 6(6):438–447PubMedCrossRef Wang M et al (2021) Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours: a multicentre, open-label, randomised controlled trial. Lancet Gastroenterol Hepatol 6(6):438–447PubMedCrossRef
55.
Zurück zum Zitat Nickel F et al (2020) Laparoscopic versus open pancreaticoduodenectomy: a systematic review and meta-analysis of randomized controlled trials. Ann Surg 271(1):54–66PubMedCrossRef Nickel F et al (2020) Laparoscopic versus open pancreaticoduodenectomy: a systematic review and meta-analysis of randomized controlled trials. Ann Surg 271(1):54–66PubMedCrossRef
57.
Zurück zum Zitat Krautz C et al (2018) Effect of hospital volume on in-hospital morbidity and mortality following pancreatic surgery in Germany. Ann Surg 267(3):411–417PubMedCrossRef Krautz C et al (2018) Effect of hospital volume on in-hospital morbidity and mortality following pancreatic surgery in Germany. Ann Surg 267(3):411–417PubMedCrossRef
58.
Zurück zum Zitat Finks JF, Osborne NH, Birkmeyer JD (2011) Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med 364(22):2128–2137PubMedPubMedCentralCrossRef Finks JF, Osborne NH, Birkmeyer JD (2011) Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med 364(22):2128–2137PubMedPubMedCentralCrossRef
59.
Zurück zum Zitat de Wilde RF et al (2012) Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J Surg 99(3):404–410PubMedCrossRef de Wilde RF et al (2012) Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J Surg 99(3):404–410PubMedCrossRef
60.
Zurück zum Zitat Uhl W et al (2021) Statement of the surgical working group for liver, gall bladder and pancreatic diseases (CALGP) of the German Society for General and Visceral Surgery (DGAV) on rapid report V19-03: association between volume of cases and quality in complex pancreatic surgery. Chirurg 92(5):444–447PubMedCrossRef Uhl W et al (2021) Statement of the surgical working group for liver, gall bladder and pancreatic diseases (CALGP) of the German Society for General and Visceral Surgery (DGAV) on rapid report V19-03: association between volume of cases and quality in complex pancreatic surgery. Chirurg 92(5):444–447PubMedCrossRef
Metadaten
Titel
Chirurgische Therapie des Pankreaskarzinoms – was gibt es Neues?
verfasst von
Univ.-Prof. Dr. Dr. med. Thomas Schmidt
Orlin Belyaev
Waldemar Uhl
Christiane J. Bruns
Publikationsdatum
31.03.2022
Verlag
Springer Medizin
Erschienen in
Die Chirurgie / Ausgabe 5/2022
Print ISSN: 2731-6971
Elektronische ISSN: 2731-698X
DOI
https://doi.org/10.1007/s00104-022-01618-7

Weitere Artikel der Ausgabe 5/2022

Die Chirurgie 5/2022 Zur Ausgabe

Anzeige: Webinare zu Leitlinien in der Chirurgie

S3-Leitlinie „Adulte Weichgewebesarkome“

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.