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Spezielle Resektionstechniken der Pankreaschirurgie

Artery-first‑, Uncinate-first- und Triangle-Operation
  • Thilo Hackert
Originalien
  • 18 Downloads

Zusammenfassung

Chirurgische Eingriffe am Pankreas stellen anspruchsvolle Operationen dar, die nach wie vor mit einer relevanten Morbidität verbunden sind, wogegen die Mortalität in den vergangenen Jahrzehnten in spezialisierten Zentren auf unter 5 % gesunken ist. Dies erklärt sich einerseits durch verbesserte Operationstechniken, andererseits durch die interdisziplinäre Therapie von postoperativen Komplikationen. Gleichzeitig wurden die Indikationen zur Pankreasresektion kontinuierlich ausgeweitet, insbesondere bei der Chirurgie von malignen Tumoren stellen heute erweiterte Resektionstechniken Standardvorgehen dar. In diesem Kontext spielt auch die neoadjuvante Therapie mit anschließender Resektion eine zentrale Rolle, um einerseits die Resektabilität als solche, aber auch das onkologische Ergebnis zu verbessern. In dieser Übersichtsarbeit werden spezielle Techniken der Pankreaschirurgie, die sog. „Artery-first-“ und „Uncinate first-Techniken“ sowie die „Triangle-Operation“, dargestellt.

Schlüsselwörter

Pankreaskarzinom Chirurgische Technik Artery first Uncinate first Triangle-Operation 

Special Resection Techniques for Pancreatic Surgery

Artery First, Uncinate First, and Triangle Operation

Abstract

Pancreatic operations are complex surgical procedures that are still associated with a relevant morbidity, whereas mortality has decreased below 5% in specialized centers during recent decades. On the one hand, this is explained by improved surgical techniques; on the other hand, interdisciplinary management of postoperative complications has significantly contributed to this development. Parallel to this, indications for pancreatic resections have been continuously pushed forward, especially with regard to approaches in pancreatic cancer surgery and extended resection techniques can be regarded as standard procedures today. Furthermore, neoadjuvant treatment concepts with consecutive resection play a major role today to improve resectability as well as oncological outcome for the respective patients. In this review, special surgical approaches for pancreatic cancer resection, i.e., the so-called artery first and uncinate first approaches as well as the triangle operation, are summarized.

Keywords

Pancreatic cancer Surgical technique Artery first Uncinate first Triangle operation 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

T. Hackert gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Quante AS, Ming C, Rottmann M, Engel J, Boeck S, Heinemann V, Westphalen CB, Strauch K (2016) Projections of cancer incidence and cancer-related deaths in Germany by 2020 and 2030. Cancer Med 5:2649–2656CrossRefGoogle Scholar
  2. 2.
    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, Löhr M, Lüttges J, Lutz M, Mayerle J, Michl P, Möller P, Molls M, Münter M, Nothacker M, Oettle H, Post S, Reinacher-Schick A, Röcken 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, Guidelines Programme Oncology AWMF, German Cancer Society e.V., German Cancer Aid (2013) S3-guideline exocrine pancreatic cancer. Z Gastroenterol 51:1395–1440CrossRefGoogle Scholar
  3. 3.
    Fortner JG (1973) Regional resection of cancer of the pancreas: a new surgical approach. Surgery 73:307–320PubMedGoogle Scholar
  4. 4.
    Hartwig W, Gluth A, Hinz U, Koliogiannis D, Strobel O, Hackert T, Werner J, Büchler MW (2016) Outcomes after extended pancreatectomy in patients with borderline resectable and locally advanced pancreatic cancer. Br J Surg 103:1683–1694CrossRefGoogle Scholar
  5. 5.
    Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346:1128–1137CrossRefGoogle Scholar
  6. 6.
    Stampfl U, Hackert T, Sommer CM, Klauss M, Bellemann N, Siebert S, Werner J, Richter GM, Kauczor HU, Radeleff B (2012) Superselective embolization for the management of postpancreatectomy hemorrhage: a single-center experience in 25 patients. J Vasc Interv Radiol 23:504–510CrossRefGoogle Scholar
  7. 7.
    Sanjay P, Takaori K, Govil S, Shrikhande SV, Windsor JA (2012) ‘Artery-first’ approaches to pancreatoduodenectomy. Br J Surg 99:1027–1035CrossRefGoogle Scholar
  8. 8.
    Weitz J, Rahbari N, Koch M, Buchler MW (2010) The “artery first” approach for resection of pancreatic head cancer. J Am Coll Surg 210:e1–4CrossRefGoogle Scholar
  9. 9.
    Pessaux P, Varma D, Arnaud JP (2006) Pancreaticoduodenectomy: superior mesenteric artery first approach. J Gastrointest Surg 10:607–611CrossRefGoogle Scholar
  10. 10.
    Inoue Y, Saiura A, Yoshioka R, Ono Y, Takahashi M, Arita J, Takahashi Y, Koga R (2015) Pancreatoduodenectomy with systematic mesopancreas dissection using a supracolic anterior artery-first approach. Ann Surg 262:1092–1101CrossRefGoogle Scholar
  11. 11.
    Ironside N, Barreto SG, Loveday B, Shrikhande SV, Windsor JA, Pandanaboyana S (2018) Meta-analysis of an artery-first approach versus standard pancreatoduodenectomy on perioperative outcomes and survival. Br J Surg 105:628–636CrossRefGoogle Scholar
  12. 12.
    Hackert T, Werner J, Weitz J, Schmidt J, Büchler MW (2010) Uncinate process first—a novel approach for pancreatic head resection. Langenbecks Arch Surg 395:1161–1164CrossRefGoogle Scholar
  13. 13.
    Tol JA, Gouma DJ, Bassi C, Dervenis C, Montorsi M, Adham M, Andrén-Sandberg A, Asbun HJ, Bockhorn M, Büchler MW, Conlon KC, Fernández-Cruz L, Fingerhut A, Friess H, Hartwig W, Izbicki JR, Lillemoe KD, Milicevic MN, Neoptolemos JP, Shrikhande SV, Vollmer CM, Yeo CJ, Charnley RM, International Study Group on Pancreatic Surgery. (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 156:591–600CrossRefGoogle Scholar
  14. 14.
    Shrikhande SV, Barreto SG, Bodhankar YD, Suradkar K, Shetty G, Hawaldar R, Goel M, Shukla PJ (2011) Superior mesenteric artery first combined with uncinate process approach versus uncinate process first approach in pancreatoduodenectomy: a comparative study evaluating perioperative outcomes. Langenbecks Arch Surg 396:1205–1212CrossRefGoogle Scholar
  15. 15.
    Tempero MA, Malafa MP, Al-Hawary M, Asbun H, Bain A, Behrman SW, Benson AB 3rd, Binder E, Cardin DB, Cha C, Chiorean EG, Chung V, Czito B, Dillhoff M, Dotan E, Ferrone CR, Hardacre J, Hawkins WG, Herman J, Ko AH, Komanduri S, Koong A, LoConte N, Lowy AM, Moravek C, Nakakura EK, O’Reilly EM, Obando J, Reddy S, Scaife C, Thayer S, Weekes CD, Wolff RA, Wolpin BM, Burns J, Darlow S (2017) Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 15:1028–1061CrossRefGoogle Scholar
  16. 16.
    Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, Asbun HJ, Bassi C, Büchler M, Charnley RM, Conlon K, Cruz LF, Dervenis C, Fingerhutt A, Friess H, Gouma DJ, Hartwig W, Lillemoe KD, Montorsi M, Neoptolemos JP, Shrikhande SV, Takaori K, Traverso W, Vashist YK, Vollmer C, Yeo CJ, Izbicki JR, International Study Group of Pancreatic Surgery. (2014) Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 155:977–988CrossRefGoogle Scholar
  17. 17.
    Isaji S, Mizuno S, Windsor JA, Bassi C, Fernández-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 18:2–11CrossRefGoogle Scholar
  18. 18.
    Jang JY, Han Y, Lee H, Kim SW, Kwon W, Lee KH, Oh DY, Chie EK, Lee JM, Heo JS, Park JO, Lim DH, Kim SH, Park SJ, Lee WJ, Koh YH, Park JS, Yoon DS, Lee IJ, Choi SH (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 268:215–222CrossRefGoogle Scholar
  19. 19.
    Zhou Y, Zhang Z, Liu Yl LB, Xu D (2012) Pancreatectomy combined with superior mesenteric vein-portal vein resection for pancreatic cancer: a meta-analysis. World J Surg 36:884–889CrossRefGoogle Scholar
  20. 20.
    Giovinazzo F, Turri G, Katz MH, Heaton N, Ahmed I (2016) Meta-analysis of benefits of portal-superior mesenteric vein resection in pancreatic resection for ductal adenocarcinoma. Br J Surg 103:179–191CrossRefGoogle Scholar
  21. 21.
    Wagner M, Antunes C, Pietrasz D, Cassinotto C, Zappa M, Sa Cunha A, Lucidarme O, Bachet JB (2017) CT evaluation after neoadjuvant FOLFIRINOX chemotherapy for borderline and locally advanced pancreatic adenocarcinoma. Eur Radiol 27:3104–3116CrossRefGoogle Scholar
  22. 22.
    Mollberg N, Rahbari NN, Koch M, Hartwig W, Hoeger Y, Büchler MW, Weitz J (2011) Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg 254:882–893CrossRefGoogle Scholar
  23. 23.
    Hackert T, Strobel O, Michalski CW, Mihaljevic AL, Mehrabi A, Müller-Stich B, Berchtold C, Ulrich A, Büchler MW (2017) The TRIANGLE operation—radical surgery after neoadjuvant treatment for advanced pancreatic cancer: a single arm observational study. HPB (Oxford) 19:1001–1007CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Allgemein‑, Viszeral- und TransplantationschirurgieUniversitätsklinikum HeidelbergHeidelbergDeutschland

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