[Current diagnosis and treatment of pancreatic cancer].
Adenocarcinoma of the pancreas (pancreatic cancer) is the most frequent tumor entity in the pancreas. While the results of surgical therapy of pancreatic cancer were disappointing in the past due to high perioperative mortality rates, resection of pancreatic cancer nowadays represents the standard treatment for non-metastatic cancer with a mortality rate below 5%. This decrease in perioperative mortality of the Whipple operation is inversely correlated to the case load of the hospital and the responsible surgeon, and is mainly related to improvements in the intensive care management, the surgical technique and patient selection. In particular, the perioperative use of octreotide resulted in a significant decrease in the rate of pancreatic fistula. Furthermore, modern staging examinations such as diagnostic laparoscopy, PET, or endoscopic ultrasound resulted in improved patient selection. In addition, the long-term results of the surgical treatment of pancreatic cancer has been improved by adjuvant and neoadjuvant chemotherapy in the past 10 years. Similar progress has been made in the palliative treatment of metastatic or locally advanced cancer. Nowadays, endoscopic procedures can replace surgical palliation of obstructive jaundice in most cases and sometimes even gastric outlet obstruction. Moreover, systemic chemotherapy using gemcitabine-based protocols has resulted in a significant prolongation of survival. However, further progress in the treatment of pancreatic cancer can only be achieved by an interdisciplinary management of this disease.
Heinrich
S
S
Klinik für Viszeral-und Transplantationschirurgie, Universitätsspital Zürich.
Schäfer
M
M
Bauerfeind
P
P
Pestalozzi
B C
BC
Clavien
P A
PA
D000230:Adenocarcinoma / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D000367:Age Factors; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D010179:Pancreas / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D011860:Radiography, Abdominal; D012307:Risk Factors; D012737:Sex Factors; D014057:Tomography, X-Ray Computed