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Erschienen in: Die Onkologie 8/2019

22.05.2019 | Pankreaskarzinom | Leitthema

Aktuelle Standards und Perspektiven in der Chirurgie des Pankreaskarzinoms

verfasst von: PD Dr. med. Jan G. D’Haese, Dr. med. Bernhard W. Renz, Prof. Dr. med. Jens Werner

Erschienen in: Die Onkologie | Ausgabe 8/2019

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Zusammenfassung

Hintergrund

Die Behandlung des Pankreaskarzinoms hat in den letzten Jahren deutliche Fortschritte gemacht. In Kombination mit einer (neo)adjuvanten Chemotherapie ist die chirurgische Resektion der einzige kurative Therapieansatz.

Ziel der Arbeit

Aktuelle Standards und möglicher Perspektiven in der Chirurgie des Pankreaskarzinoms sollen dargestellt werden.

Material und Methoden

Es erfolgten eine selektive Literaturrecherche und Zusammenfassung der derzeitigen Evidenz zur chirurgischen Behandlung lokaler und lokal fortgeschrittener Pankreaskarzinome.

Ergebnisse

Die chirurgische Therapie des primär resektablen Pankreaskarzinoms ist heute in spezialisierten Zentren hochgradig standardisiert. Bei Borderline-resektablen Pankreaskarzinomen, bei denen primär sicher keine R0-Resektion erreicht werden kann, wird durch Einsatz einer neoadjuvanten Chemotherapie eine sekundäre Resektabilität angestrebt. Beim primär irresektablen, lokal fortgeschrittenen Pankreaskarzinom stehen sequenzielle Therapiekonzepte, die systemische Therapie, Strahlentherapie und Chirurgie beinhalten, im Vordergrund. Primäre und sekundäre Resektionen sind heute in entsprechenden Zentren sehr sicher mit einer geringen Morbidität und Mortalität durchführbar.

Schlussfolgerungen

Die Behandlung von insbesondere Borderline-resektabler und lokal fortgeschrittener Pankreaskarzinome ist eine interdisziplinäre Herausforderung und sollte an speziellen Pankreaszentren erfolgen.
Literatur
1.
Zurück zum Zitat Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS (2007) National failure to operate on early stage pancreatic cancer. Ann Surg 246(2):173–180CrossRef Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS (2007) National failure to operate on early stage pancreatic cancer. Ann Surg 246(2):173–180CrossRef
2.
Zurück zum Zitat Hartwig W, Hackert T, Hinz U, Gluth A, Bergmann F, Strobel O, Buchler MW, Werner J (2011) Pancreatic cancer surgery in the new millennium: better prediction of outcome. Ann Surg 254(2):311–319CrossRef Hartwig W, Hackert T, Hinz U, Gluth A, Bergmann F, Strobel O, Buchler MW, Werner J (2011) Pancreatic cancer surgery in the new millennium: better prediction of outcome. Ann Surg 254(2):311–319CrossRef
3.
Zurück zum Zitat Neoptolemos JP, Stocken DD, Bassi C, Ghaneh P, Cunningham D, Goldstein D, Padbury R, Moore MJ, Gallinger S, Mariette C, Wente MN, Izbicki JR, Friess H, Lerch MM, Dervenis C, Olah A, Butturini G, Doi R, Lind PA, Smith D, Valle JW, Palmer DH, Buckels JA, Thompson J, McKay CJ, Rawcliffe CL, Buchler MW (2010) Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA 304(10):1073–1081CrossRef Neoptolemos JP, Stocken DD, Bassi C, Ghaneh P, Cunningham D, Goldstein D, Padbury R, Moore MJ, Gallinger S, Mariette C, Wente MN, Izbicki JR, Friess H, Lerch MM, Dervenis C, Olah A, Butturini G, Doi R, Lind PA, Smith D, Valle JW, Palmer DH, Buckels JA, Thompson J, McKay CJ, Rawcliffe CL, Buchler MW (2010) Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA 304(10):1073–1081CrossRef
4.
Zurück zum Zitat Strobel O, Hank T, Hinz U, Bergmann F, Schneider L, Springfeld C, Jager D, Schirmacher P, Hackert T, Buchler MW (2017) Pancreatic cancer surgery: the new R‑status counts. Ann Surg 265(3):565–573CrossRef Strobel O, Hank T, Hinz U, Bergmann F, Schneider L, Springfeld C, Jager D, Schirmacher P, Hackert T, Buchler MW (2017) Pancreatic cancer surgery: the new R‑status counts. Ann Surg 265(3):565–573CrossRef
5.
Zurück zum Zitat Conroy T, Hammel P, Hebbar M, Abdelghani MB, Wei AC, Raoul JL, Chone L, Francois E, Artru P, Biagi JJ, Lecomte T, Assenat E, Faroux R, Ychou M, Volet J, Sauvanet A, Breysacher G, Di Fiore F, Cripps C, Kavan P, Texereau P, Bouhier-Leporrier K, Khemissa-Akouz F, Legoux JL, Juzyna B, Gourgou S, O’Callaghan CJ, Jouffroy-Zeller C, Rat P, Malka D, Castan F, Bachet JB (2018) FOLFIRINOX or Gemcitabine as Adjuvant therapy for pancreatic cancer. N Engl J Med 379(25):2395–2406CrossRef Conroy T, Hammel P, Hebbar M, Abdelghani MB, Wei AC, Raoul JL, Chone L, Francois E, Artru P, Biagi JJ, Lecomte T, Assenat E, Faroux R, Ychou M, Volet J, Sauvanet A, Breysacher G, Di Fiore F, Cripps C, Kavan P, Texereau P, Bouhier-Leporrier K, Khemissa-Akouz F, Legoux JL, Juzyna B, Gourgou S, O’Callaghan CJ, Jouffroy-Zeller C, Rat P, Malka D, Castan F, Bachet JB (2018) FOLFIRINOX or Gemcitabine as Adjuvant therapy for pancreatic cancer. N Engl J Med 379(25):2395–2406CrossRef
6.
Zurück zum Zitat Hartwig W, Hackert T, Hinz U, Hassenpflug M, Strobel O, Buchler MW, Werner J (2009) Multivisceral resection for pancreatic malignancies: risk-analysis and long-term outcome. Ann Surg 250(1):81–87CrossRef Hartwig W, Hackert T, Hinz U, Hassenpflug M, Strobel O, Buchler MW, Werner J (2009) Multivisceral resection for pancreatic malignancies: risk-analysis and long-term outcome. Ann Surg 250(1):81–87CrossRef
7.
Zurück zum Zitat Gillen S, Schuster T, Meyer Zum Buschenfelde C, Friess H, Kleeff J (2010) Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. plos Med 7(4):e1000267CrossRef Gillen S, Schuster T, Meyer Zum Buschenfelde C, Friess H, Kleeff J (2010) Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. plos Med 7(4):e1000267CrossRef
8.
Zurück zum Zitat Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, Lee JE, Pisters PW, Evans DB, Wolff RA (2006) Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol 13(8):1035–1046CrossRef Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, Lee JE, Pisters PW, Evans DB, Wolff RA (2006) Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol 13(8):1035–1046CrossRef
9.
Zurück zum Zitat Hoffman JP, Weese JL, Solin LJ, Engstrom P, Agarwal P, Barber LW, Guttmann MC, Litwin S, Salazar H, Eisenberg BL (1995) A pilot study of preoperative chemoradiation for patients with localized adenocarcinoma of the pancreas. Am J Surg 169(1):71–77 (discussion 77–8)CrossRef Hoffman JP, Weese JL, Solin LJ, Engstrom P, Agarwal P, Barber LW, Guttmann MC, Litwin S, Salazar H, Eisenberg BL (1995) A pilot study of preoperative chemoradiation for patients with localized adenocarcinoma of the pancreas. Am J Surg 169(1):71–77 (discussion 77–8)CrossRef
10.
Zurück zum Zitat Seufferlein T, Porzner M, Becker T, Budach V, Ceyhan G, Esposito I, Fietkau R, Follmann M, Friess H, Galle P, Geissler M, Glanemann M, Gress T, Heinemann V, Hohenberger W, Hopt U, Izbicki J, Klar E, Kleeff J, Kopp I, Kullmann F, Langer T, Langrehr J, Lerch M, Lohr M, Luttges J, Lutz M, Mayerle J, Michl P, Moller P, Molls M, Munter M, Nothacker M, Oettle H, Post S, Reinacher-Schick A, Rocken C, Roeb E, Saeger H, Schmid R, Schmiegel W, Schoenberg M, Siveke J, Stuschke M, Tannapfel A, Uhl W, Unverzagt S, van Oorschot B, Vashist Y, Werner J, Yekebas E (2013) S3-guideline exocrine pancreatic cancer. Z Gastroenterol 51(12):1395–1440CrossRef Seufferlein T, Porzner M, Becker T, Budach V, Ceyhan G, Esposito I, Fietkau R, Follmann M, Friess H, Galle P, Geissler M, Glanemann M, Gress T, Heinemann V, Hohenberger W, Hopt U, Izbicki J, Klar E, Kleeff J, Kopp I, Kullmann F, Langer T, Langrehr J, Lerch M, Lohr M, Luttges J, Lutz M, Mayerle J, Michl P, Moller P, Molls M, Munter M, Nothacker M, Oettle H, Post S, Reinacher-Schick A, Rocken C, Roeb E, Saeger H, Schmid R, Schmiegel W, Schoenberg M, Siveke J, Stuschke M, Tannapfel A, Uhl W, Unverzagt S, van Oorschot B, Vashist Y, Werner J, Yekebas E (2013) S3-guideline exocrine pancreatic cancer. Z Gastroenterol 51(12):1395–1440CrossRef
11.
Zurück zum Zitat Evans DB, Varadhachary GR, Crane CH, Sun CC, Lee JE, Pisters PW, Vauthey JN, Wang H, Cleary KR, Staerkel GA, Charnsangavej C, Lano EA, Ho L, Lenzi R, Abbruzzese JL, Wolff RA (2008) Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol 26(21):3496–3502CrossRef Evans DB, Varadhachary GR, Crane CH, Sun CC, Lee JE, Pisters PW, Vauthey JN, Wang H, Cleary KR, Staerkel GA, Charnsangavej C, Lano EA, Ho L, Lenzi R, Abbruzzese JL, Wolff RA (2008) Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol 26(21):3496–3502CrossRef
12.
Zurück zum Zitat Werner J, Combs SE, Springfeld C, Hartwig W, Hackert T, Buchler MW (2013) Advanced-stage pancreatic cancer: therapy options. Nat Rev Clin Oncol 10(6):323–333CrossRef Werner J, Combs SE, Springfeld C, Hartwig W, Hackert T, Buchler MW (2013) Advanced-stage pancreatic cancer: therapy options. Nat Rev Clin Oncol 10(6):323–333CrossRef
13.
Zurück zum Zitat Isaji S, Mizuno S, Windsor JA, Bassi C, Fernandez-Del Castillo C, Hackert T, Hayasaki A, Katz MHG, Kim SW, Kishiwada M, Kitagawa H, Michalski CW, Wolfgang CL (2018) International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. Pancreatology 18(1):2–11CrossRef Isaji S, Mizuno S, Windsor JA, Bassi C, Fernandez-Del Castillo C, Hackert T, Hayasaki A, Katz MHG, Kim SW, Kishiwada M, Kitagawa H, Michalski CW, Wolfgang CL (2018) International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. Pancreatology 18(1):2–11CrossRef
14.
Zurück zum Zitat Mollberg N, Rahbari NN, Koch M, Hartwig W, Hoeger Y, Buchler MW, Weitz J (2011) Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg 254(6):882–893CrossRef Mollberg N, Rahbari NN, Koch M, Hartwig W, Hoeger Y, Buchler MW, Weitz J (2011) Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg 254(6):882–893CrossRef
15.
Zurück zum Zitat Klauss M, Alt CD, Welzel T, Werner J, Buchler MW, Richter GM, Kauffmann GW, Kauczor HU, Grenacher L (2009) Multidetector CT evaluation of the course of nonresectable pancreatic carcinomas with neoadjuvant therapy. Pancreatology 9(5):621–630CrossRef Klauss M, Alt CD, Welzel T, Werner J, Buchler MW, Richter GM, Kauffmann GW, Kauczor HU, Grenacher L (2009) Multidetector CT evaluation of the course of nonresectable pancreatic carcinomas with neoadjuvant therapy. Pancreatology 9(5):621–630CrossRef
16.
Zurück zum Zitat Morgan DE, Waggoner CN, Canon CL, Lockhart ME, Fineberg NS, Posey JA 3rd, Vickers SM (2010) Resectability of pancreatic adenocarcinoma in patients with locally advanced disease downstaged by preoperative therapy: a challenge for MDCT. Ajr Am J Roentgenol 194(3):615–622CrossRef Morgan DE, Waggoner CN, Canon CL, Lockhart ME, Fineberg NS, Posey JA 3rd, Vickers SM (2010) Resectability of pancreatic adenocarcinoma in patients with locally advanced disease downstaged by preoperative therapy: a challenge for MDCT. Ajr Am J Roentgenol 194(3):615–622CrossRef
17.
Zurück zum Zitat Tol JA, Gouma DJ, Bassi C, Dervenis C, Montorsi M, Adham M, Andren-Sandberg A, Asbun HJ, Bockhorn M, Buchler MW, Conlon KC, Fernandez-Cruz L, Fingerhut A, Friess H, Hartwig W, Izbicki JR, Lillemoe KD, Milicevic MN, Neoptolemos JP, Shrikhande SV, Vollmer CM, Yeo CJ, Charnley RM (2014) Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery 156(3):591–600CrossRef Tol JA, Gouma DJ, Bassi C, Dervenis C, Montorsi M, Adham M, Andren-Sandberg A, Asbun HJ, Bockhorn M, Buchler MW, Conlon KC, Fernandez-Cruz L, Fingerhut A, Friess H, Hartwig W, Izbicki JR, Lillemoe KD, Milicevic MN, Neoptolemos JP, Shrikhande SV, Vollmer CM, Yeo CJ, Charnley RM (2014) Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery 156(3):591–600CrossRef
18.
Zurück zum Zitat Huttner FJ, Fitzmaurice C, Schwarzer G, Seiler CM, Antes G, Buchler MW, Diener MK (2016) Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database Syst Rev 2:CD6053PubMed Huttner FJ, Fitzmaurice C, Schwarzer G, Seiler CM, Antes G, Buchler MW, Diener MK (2016) Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database Syst Rev 2:CD6053PubMed
19.
Zurück zum Zitat Diener MK, Seiler CM, Rossion I, Kleeff J, Glanemann M, Butturini G, Tomazic A, Bruns CJ, Busch OR, Farkas S, Belyaev O, Neoptolemos JP, Halloran C, Keck T, Niedergethmann M, Gellert K, Witzigmann H, Kollmar O, Langer P, Steger U, Neudecker J, Berrevoet F, Ganzera S, Heiss MM, Luntz SP, Bruckner T, Kieser M, Buchler MW (2011) Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet 377(9776):1514–1522CrossRef Diener MK, Seiler CM, Rossion I, Kleeff J, Glanemann M, Butturini G, Tomazic A, Bruns CJ, Busch OR, Farkas S, Belyaev O, Neoptolemos JP, Halloran C, Keck T, Niedergethmann M, Gellert K, Witzigmann H, Kollmar O, Langer P, Steger U, Neudecker J, Berrevoet F, Ganzera S, Heiss MM, Luntz SP, Bruckner T, Kieser M, Buchler MW (2011) Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet 377(9776):1514–1522CrossRef
20.
Zurück zum Zitat Mitchem JB, Hamilton N, Gao F, Hawkins WG, Linehan DC, Strasberg SM (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):46–52CrossRef Mitchem JB, Hamilton N, Gao F, Hawkins WG, Linehan DC, Strasberg SM (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):46–52CrossRef
21.
Zurück zum Zitat de Rooij T, van Hilst J, van Santvoort H, Boerma D, van den Boezem P, Daams F, van Dam R, Dejong C, van Duyn E, Dijkgraaf M, van Eijck C, Festen S, Gerhards M, Groot Koerkamp B, de Hingh I, Kazemier G, Klaase J, de Kleine R, van Laarhoven C, Luyer M, Patijn G, Steenvoorde P, Suker M, Abu Hilal M, Busch O, Besselink M, Dutch Pancreatic Cancer Group (2019) Minimally Invasive Versus Open Distal Pancreatectomy (LEOPARD): A Multicenter Patient-blinded Randomized Controlled Trial. Ann Surg 269(1):2–9. https://doi.org/10.1097/SLA.0000000000002979 CrossRefPubMed de Rooij T, van Hilst J, van Santvoort H, Boerma D, van den Boezem P, Daams F, van Dam R, Dejong C, van Duyn E, Dijkgraaf M, van Eijck C, Festen S, Gerhards M, Groot Koerkamp B, de Hingh I, Kazemier G, Klaase J, de Kleine R, van Laarhoven C, Luyer M, Patijn G, Steenvoorde P, Suker M, Abu Hilal M, Busch O, Besselink M, Dutch Pancreatic Cancer Group (2019) Minimally Invasive Versus Open Distal Pancreatectomy (LEOPARD): A Multicenter Patient-blinded Randomized Controlled Trial. Ann Surg 269(1):2–9. https://​doi.​org/​10.​1097/​SLA.​0000000000002979​ CrossRefPubMed
22.
Zurück zum Zitat Burdelski CM, Reeh M, Bogoevski D, Gebauer F, Tachezy M, Vashist YK, Cataldegirmen G, Yekebas E, Izbicki JR, Bockhorn M (2011) Multivisceral resections in pancreatic cancer: identification of risk factors. World J Surg 35(12):2756–2763CrossRef Burdelski CM, Reeh M, Bogoevski D, Gebauer F, Tachezy M, Vashist YK, Cataldegirmen G, Yekebas E, Izbicki JR, Bockhorn M (2011) Multivisceral resections in pancreatic cancer: identification of risk factors. World J Surg 35(12):2756–2763CrossRef
23.
Zurück zum Zitat Zhou Y, Zhang Z, Liu Y, Li B, Xu D (2012) Pancreatectomy combined with superior mesenteric vein-portal vein resection for pancreatic cancer: a meta-analysis. World J Surg 36(4):884–891CrossRef Zhou Y, Zhang Z, Liu Y, Li B, Xu D (2012) Pancreatectomy combined with superior mesenteric vein-portal vein resection for pancreatic cancer: a meta-analysis. World J Surg 36(4):884–891CrossRef
24.
Zurück zum Zitat Chua TC, Saxena A (2010) Extended pancreaticoduodenectomy with vascular resection for pancreatic cancer: a systematic review. J Gastrointest Surg 14(9):1442–1452CrossRef Chua TC, Saxena A (2010) Extended pancreaticoduodenectomy with vascular resection for pancreatic cancer: a systematic review. J Gastrointest Surg 14(9):1442–1452CrossRef
25.
Zurück zum Zitat Ferrone CR, Marchegiani G, Hong TS, Ryan DP, Deshpande V, McDonnell EI, Sabbatino F, Santos DD, Allen JN, Blaszkowsky LS, Clark JW, Faris JE, Goyal L, Kwak EL, Murphy JE, Ting DT, Wo JY, Zhu AX, Warshaw AL, Lillemoe KD, Fernandez-del Castillo C (2015) Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann Surg 261(1):12–17CrossRef Ferrone CR, Marchegiani G, Hong TS, Ryan DP, Deshpande V, McDonnell EI, Sabbatino F, Santos DD, Allen JN, Blaszkowsky LS, Clark JW, Faris JE, Goyal L, Kwak EL, Murphy JE, Ting DT, Wo JY, Zhu AX, Warshaw AL, Lillemoe KD, Fernandez-del Castillo C (2015) Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann Surg 261(1):12–17CrossRef
26.
Zurück zum Zitat Strobel O, Berens V, Hinz U, Hartwig W, Hackert T, Bergmann F, Debus J, Jager D, Buchler MW, Werner J (2012) Resection after neoadjuvant therapy for locally advanced, “unresectable” pancreatic cancer. Surgery 152(3 Suppl 1):33–42CrossRef Strobel O, Berens V, Hinz U, Hartwig W, Hackert T, Bergmann F, Debus J, Jager D, Buchler MW, Werner J (2012) Resection after neoadjuvant therapy for locally advanced, “unresectable” pancreatic cancer. Surgery 152(3 Suppl 1):33–42CrossRef
27.
Zurück zum Zitat Hackert T, Strobel O, Michalski CW, Mihaljevic AL, Mehrabi A, Muller-Stich B, Berchtold C, Ulrich A, Buchler MW (2017) The TRIANGLE operation—radical surgery after neoadjuvant treatment for advanced pancreatic cancer: a single arm observational study. HPB (Oxford) 19(11):1001–1007CrossRef Hackert T, Strobel O, Michalski CW, Mihaljevic AL, Mehrabi A, Muller-Stich B, Berchtold C, Ulrich A, Buchler MW (2017) The TRIANGLE operation—radical surgery after neoadjuvant treatment for advanced pancreatic cancer: a single arm observational study. HPB (Oxford) 19(11):1001–1007CrossRef
28.
Zurück zum Zitat Krautz C, Nimptsch U, Weber GF, Mansky T, Grutzmann R (2018) Effect of hospital volume on in-hospital morbidity and mortality following pancreatic surgery in Germany. Ann Surg 267(3):411–417CrossRef Krautz C, Nimptsch U, Weber GF, Mansky T, Grutzmann R (2018) Effect of hospital volume on in-hospital morbidity and mortality following pancreatic surgery in Germany. Ann Surg 267(3):411–417CrossRef
29.
Zurück zum Zitat Birkmeyer JD, Sun Y, Wong SL, Stukel TA (2007) Hospital volume and late survival after cancer surgery. Ann Surg 245(5):777–783CrossRef Birkmeyer JD, Sun Y, Wong SL, Stukel TA (2007) Hospital volume and late survival after cancer surgery. Ann Surg 245(5):777–783CrossRef
30.
Zurück zum Zitat Gooiker GA, van der Geest LG, Wouters MW, Vonk M, Karsten TM, Tollenaar RA, Bonsing BA (2011) Quality improvement of pancreatic surgery by centralization in the western part of the Netherlands. Ann Surg Oncol 18(7):1821–1829CrossRef Gooiker GA, van der Geest LG, Wouters MW, Vonk M, Karsten TM, Tollenaar RA, Bonsing BA (2011) Quality improvement of pancreatic surgery by centralization in the western part of the Netherlands. Ann Surg Oncol 18(7):1821–1829CrossRef
31.
Zurück zum Zitat Kruger S, Haas M, Burger PJ, Ormanns S, Modest DP, Westphalen CB, Michl M, Kleespies A, Angele MK, Hartwig W, Bruns CJ, Niyazi M, Roeder F, Kirchner T, Werner J, Heinemann V, Boeck S (2016) Isolated pulmonary metastases define a favorable subgroup in metastatic pancreatic cancer. Pancreatology 16(4):593–598CrossRef Kruger S, Haas M, Burger PJ, Ormanns S, Modest DP, Westphalen CB, Michl M, Kleespies A, Angele MK, Hartwig W, Bruns CJ, Niyazi M, Roeder F, Kirchner T, Werner J, Heinemann V, Boeck S (2016) Isolated pulmonary metastases define a favorable subgroup in metastatic pancreatic cancer. Pancreatology 16(4):593–598CrossRef
Metadaten
Titel
Aktuelle Standards und Perspektiven in der Chirurgie des Pankreaskarzinoms
verfasst von
PD Dr. med. Jan G. D’Haese
Dr. med. Bernhard W. Renz
Prof. Dr. med. Jens Werner
Publikationsdatum
22.05.2019
Verlag
Springer Medizin
Erschienen in
Die Onkologie / Ausgabe 8/2019
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-019-0584-3

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