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Mehr InformationenBA05-9783437228698.10001-8
10.1016/BA05-9783437228698.10001-8
A05-9783437228698
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Pankreas
A5.1
Akute Pankreatitis
Definition und Basisinformationen
Symptomatik und klinisches Bild
Diagnostik und Differenzialdiagnostik
Schweregrad der Pankreatitis
Therapie
Autoren
A5.2
Chronische Pankreatitis und Autoimmunpankreatitis
Definition und Basisinformation
Diagnostik und Differenzialdiagnostik
Therapie
Langzeitverlauf und Prognose
5.2.1
Autoimmunpankreatitis
Autoren
A5.3
Neoplasien des Pankreas
5.3.1
Intrapapilläre muzinöse Neoplasie
Epidemiologie
Klassifikation und genetische Veränderungen
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Lokalisation,
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Dysplasiegrad und
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histologischer Subtyp.
Klinik
Diagnostik
Therapie
Malignitätsrisiko und Resektion von IPMN
Überwachung von IPMN
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Ikterus plus zystische Pankreasläsion,
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kontrastmittelaufnehmende solide Läsion > 5 mm und
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Hauptgangdilatation > 10 mm.
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Zystengröße > 3 bzw. > 4 cm,
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verdickte Zystenwand,
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Hauptgang zwischen 5 und 9 mm,
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nicht Kontrastmittel (KM) aufnehmende solide Anteile sowie KM aufnehmende Läsionen < 5 mm und
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Pankreasgangkalibersprünge mit sekundärer Pankreasatrophie.
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einen erhöhten CA19-9-Wert (> 37 U/l) sowie
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eine Wachstumsrate > 5 mm/Jahr.
Fazit
Autorenadressen
5.3.2
Duktales Pankreaskarzinom
Histologische Klassifikation und Epidemiologie
Prävention und Risikofaktoren
Ernährung
Prophylaxe
Risikogruppen
Diagnostik
Bildgebung
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Oberbauchsonographie (Empfehlungsgrad B), bei einer Pankreatitis auch mittels Endosonographie
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Multidetektor-Computertomographie (MD-CT) mit biphasischem Kontrastmittelprotokoll oder Magnetresonanztomographie (MRT) mit MRCP
Zytologische und histologische Diagnostik
Therapie
Chirurgische Therapie
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Keine Fernmetastasen
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Infiltration/Encasement der V. mesenterica superior bzw. der Pfortader
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Kurzstreckiger venöser Verschluss
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Encasement der A. gastroduodenalis bis zur A. hepatica
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Ummauerung der A. mesenterica superior bis max. 180° der Gefäßzirkumferenz.
Adjuvante Therapie
Neoadjuvante Therapie
Palliative Therapie des Pankreaskarzinoms
Supportive Therapie und Nachsorge
Autorenadressen
Leitlinie
L1.
Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013 Jul–Aug;13(4 Suppl 2):e1–15. doi: 10.1016/j.pan.2013.07.063.
Literatur
1.
Huber W, Schmid RM: Diagnostik und Therapie der akuten Pankreatitis. Aktuelle Empfehlungen. Internist 52 (2011) 823–830, 832.
2.
van Santvoort HC, Bakker OJ, Bollen TL, et al.: Dutch Pancreatitis Study Group: A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology 141 (2011) 1254–1263.
Leitlinie
L1.
Hoffmeister A, et al.: S3-Consensus guidelines on definition, etiology, diagnosis and medical, endoscopic and surgical management of chronic pancreatitis. German Society of Digestive and Metabolic Diseases (DGVS). Z Gastroenterol 50 (11) (2012) 1176–1224.
Literatur
1.
Mössner J, Keim V: Therapie mit Pankreasenzymen. Dtsch Arzteblatt 108 (2011) 578–582.
2.
Keim V, Klar E, Poll M, et al.: Der pankreasoperierte Patient: Nachsorge, Diagnostik und Therapie. Dtsch Ärzteblatt 106 (2009) 789–794.
3.
Chari ST, Smyrk TC, Levy MJ, et al.: Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clin Gastroenterol Hepatol 4 (2006) 1010–1016; quiz 1934.
Leitlinien
L1.
Tanaka M, Chari S, Adsay V, et al. and International Association of Pancreatology: International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology: Official Journal of the International Association of Pancreatology 6 (2006) 17–32.
L2.
Tanaka M, Fernandez-del Castillo C, Adsay V, et al. and P. International Association of Pancreatology: International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology: Official Journal of the International Association of Pancreatology 12 (2012) 183–197.
L3
The European Study Group on Cystic Tumours of the Pancreas: European evidence-based guidelines on pancreatic cystic neoplasms. Gut 67 (2018) 789–804. doi:10.1136/gutjnl-2018-316027.
Literatur
1.
Crippa S, Bassi C, Salvia R, et al.: Low progression of intraductal papillary mucinous neoplasms with worrisome features and high-risk stigmata undergoing non-operative management: a mid-term follow-up analysis. Gut Mar;66(3) (2017) 495–506. doi: 10.1136/gutjnl-2015-310162. Epub 2016 Jan 7.
2.
de Jong K, Bruno MJ, Fockens P: Epidemiology, diagnosis, and management of cystic lesions of the pancreas. Gastroenterol Res Pract (2012) 147465.
3.
Esposito I, Schlitter A, Klöppel G: Zystische Pankreastumoren: Klassifikation und malignes Potenzial. J Gastroenterol Hepatol Erkr 9 (2011) 30–36.
4.
Farrell JJ, Fernandez-del Castillo C: Pancreatic cystic neoplasms: management and unanswered questions. Gastroenterology 144 (2013) 1303–1315.
5.
Felsenstein M, Noë M, Masica DL, et al.: IPMNs with co-occurring invasive cancers: neighbours, but not always relatives. https://www.ncbi.nlm.nih.gov/pubmed/29500184Gut 2018 Mar 2. pii: gutjnl-2017-315062. doi: 10.1136/gutjnl-2017-315062. [Epub ahead of print].
6.
Furukawa T, Kuboki Y, Tanji E, et al.: Whole-exome sequencing uncovers frequent GNAS mutations in intraductal papillary mucinous neoplasms of the pancreas. Sci Rep 1 (2011) 161.
7.
Mino-Kenudson M, Fernandez-del Castillo C, Baba Y, et al.: Prognosis of invasive intraductal papillary mucinous neoplasm depends on histological and precursor epithelial subtypes. Gut 60 (2011) 1712–1720.
8.
Mukewar S, de Pretis N, Aryal-Khanal A, et al.: Fukuoka criteria accurately predict risk for adverse outcomes during follow-up of pancreatic cysts presumed to be intraductal papillary mucinous neoplasms. Gut Oct;66(10) (2017) 1811–1817. doi: 10.1136/gutjnl-2016-311615. Epub 2016 Jul 7.
9.
Wu J, Matthaei H, Maitra A, et al.: Recurrent GNAS mutations define an unexpected pathway for pancreatic cyst development. Sci Tansl Med 3(92) (2011) 92ra66.
Leitlinien
L1.
Seufferlein T, Porzner M, Becker T, et al.: [S3-guideline exocrine pancreatic cancer]. Z Gastroenterol 51 (2013) 1395–1440.
Literatur
1.
Conroy T, Desseigne F, Ychou M, Bouche O, Groupe Tumeurs Digestives, and P. Intergroup: FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. NEJM 364 (2011) 1817–1825.
2.
Hammel P, Huguet F, Van Laethem J-L, et al.: Comparison of chemo-radiotherapy (CRT) and chemotherapy (CT) in patients with a locally advanced pancreatic cancer (LAPC) controlled after 4 months of gemcitabine with or without erlotinib: Final results of the international phase III LAP 07 study. ASCO Meeting Abstracts. 31 (2013) LBA4003.
3.
Huguet F, Girard N, Guerche CS, Hennequin C, Mornex F, Azria D: Chemoradiotherapy in the management of locally advanced pancreatic carcinoma: a qualitative systematic review. J Clin Oncol 27 (2009) 2269–2277.
4.
Moore MJ, Goldstein D, Hamm J, et al., and G. National Cancer Institute of Canada Clinical Trials: 2007. Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. L Clin Oncol 25 (2007) 1960–1966.
5.
Oettle H, Post S, Neuhaus P, et al.: Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 297 (2007) 267–277.
6.
Pelzer U, Schwaner I, Stieler J, et al.: Best supportive care (BSC) versus oxaliplatin, folinic acid and 5-fluorouracil (OFF) plus BSC in patients for second-line advanced pancreatic cancer: a phase III-study from the German CONKO-study group. Eur J Cancer 47 (2011) 1676–1681.
7.
Pelzer U, Stieler J, Roll L, et al.: Second-line therapy in refractory pancreatic cancer. results of a phase II study. Onkologie 32 (2009) 99–102.
8.
Tanno S, Nakano Y, Nishikawa T, et al.: Natural history of branch duct intraductal papillary-mucinous neoplasms of the pancreas without mural nodules: long-term follow-up results. Gut 57 (2008) 339–343.
9.
Uehara H, Nakaizumi A, Ishikawa O, et al.: Development of ductal carcinoma of the pancreas during follow-up of branch duct intraductal papillary mucinous neoplasm of the pancreas. Gut 57 (2008) 1561–1565.
10.
Valle JW, Palmer D, Jackson R, et al.: Optimal duration and timing of adjuvant chemotherapy after definitive surgery for ductal adenocarcinoma of the pancreas: ongoing lessons from the ESPAC-3 study. J Clin Oncol 32 (2014) 504–512.
11.
Von Hoff DD, Ervin T, Arena FP, et al.: Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. NEJM 369 (2013) 1691–1703.
12.
Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Buchler MW: Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. BJS 91 (2004) 586–594.
13.
RKI: Krebs in Deutschland 2013/2014.
14.
Destatis Statistisches Bundesamt 2015.
15.
Shindo K, Yu J, Suenaga M, et al.: Deleterious Germline Mutations in Patients With Apparently Sporadic Pancreatic Adenocarcinoma. J Clin Oncol 35(30) (2017) 3382–3390. doi: 10.1200/JCO.2017.72.3502.
16.
Neoptolemos JP, Palmer DH, Ghaneh P, et al.: Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet 389 (2017) 1011–1024.
17.
Wang-Gillam A, Li CP, Bodoky G; NAPOLI-1 Study Group: Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial. Lancet Feb 6;387(10018) (2016) 545–557. doi: 10.1016/S0140-6736(15)00986-1. Epub 2015 Nov 29. Erratum in: Lancet. 2016 Feb 6;387(10018):536.
18.
Oettle H, Riess H, Stieler JM, et al.: Second-line oxaliplatin, folinic acid, and fluorouracil versus folinic acid and fluorouracil alone for gemcitabine-refractory pancreatic cancer: outcomes from the CONKO-003 trial. J Clin Oncol Aug 10;32(23) (2014) 2423–2429. doi: 10.1200/JCO.2013.53.6995. Epub 2014 Jun 30.
19.
Conroy T, Hammel P, Hebbar M, et al.; Unicancer GI PRODIGE 24/CCTG PA.6 trial: A multicenter international randomized phase III trial of adjuvant mFOLFIRINOX versus gemcitabine (gem) in patients with resected pancreatic ductal adenocarcinomas. J Clin Oncol 36(suppl) (2018) abstr LBA4001.