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Wiener Medizinische Wochenschrift
Erschienen in:

01.02.2014 | main topic

Clinical approach to the patient with a solid pancreatic mass

verfasst von: Prof. Dr. Reinhold Függer, Odo Gangl, Uwe Fröschl

Erschienen in: Wiener Medizinische Wochenschrift | Ausgabe 3-4/2014

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Summary

Diagnosis and clinical work-up of a solid pancreatic mass is a challenging problem. Patients’ history, laboratory parameters, computed tomography magnetic resonance imaging, and endosonography are the cornerstones in diagnosis. Biopsy is indicated in selected patients. The main goal of surgical indication is to select patients with suspected malignancy who are resectable, but avoid unnecessary resections. About 5 % of patients resected due to suspicion of malignancy finally present with a benign histology. Autoimmune pancreatitis is the most frequent cause of such unnecessary resections.
Vorheriger Artikel Pancreatic pain
Literatur
1.
Carpelan-Holmström M, Nordling S, Pukkala E, et al. Does anyone survive pancreatic ductal adenocarcinoma? A nationwide study re-evaluating the data of the Finnish Cancer Registry. Gut. 2005;54:385–7.PubMedCentralPubMedCrossRef
2.
http://www.statistik.at/web_de/statistiken/gesundheit/krebserkrankungen/bauchspeicheldrüse/index.html.
3.
Birkmeyer JD, Siewers AD, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37.PubMedCrossRef
4.
5.
Conrad C, Fernandez-del Castillo C. Preoperative evaluation and management of the pancreatic head mass. J Surg Oncol. 2013;107:23–32.PubMedCrossRef
6.
Steinberg W. The clinical utility of the CA 19-9 tumorassociated antigen. Am J Gastroenterol. 1990;85:350–5.PubMed
7.
Bünger S, Laubert T, Roblick UJ, et al. Serum biomarkers for improved diagnostic of pancreatic cancer: a current overview. J Cancer Res Clin Oncol. 2011;137:375–89.PubMedCrossRef
8.
Fritz S, Hackert T, Hinz U, et al. Role of serum carbohydrate antigen 19-9 and carcinoembryonic antigen in distinguishing between benign and invasive intraducatal papillary mucinous neoplasm of the pancreas. Br J Surg. 2011;98:104–10.PubMedCrossRef
9.
Zatelli MC, Torta M, Leon A, et al. Chromogranin A as a marker of neuroendocrine neoplasia: an Italian multicenter study. Endocr Relat Cancer. 2007;14:473–82.PubMedCrossRef
10.
Smith SL, Rajan PS. Imaging of pancreatic adenocarcinoma with emphasis on multidetector CT. Clin Radiol. 2004;59:26–38.PubMedCrossRef
11.
Schueller G, Schima W, Schueller-Weidekamm C, et al. Multidetector CT of pancreas: effects of contrast material flow rate and individualized scan delay on enhancement of pancreas and tumor contrast. Radiology. 2006;241:441–8.PubMedCrossRef
12.
13.
Scheithauer K, Miederer M, Gaertner FC. PET-CT bei neuroendokrinen Tumoren und nuklearmedizinische Therapiemöglichkeiten. Radiologe. 2009;49:217–23.CrossRef
14.
Helmstaedter L, Riemann JF. Pancreatic cancer—EUS and early diagnosis. Langenbecks Arch Surg. 2008;393:923–7.PubMedCrossRef
15.
Rösch T, Braig C, Gain T, et al. Staging of pancreatic and ampullary carcinoma by endoscopic ultrasonography. Comparison with conventionalsonography, computed tomography, and angiography. Gastroenterology. 1992;102:188–99.PubMed
16.
Schöfl R. Pancreatic carcinoma—diagnosis and screening—endoscopic therapy. Wien Klin Wochenschr. 1994;106:698–700.PubMed
17.
Lermite E, Pessaux P, Teyssedou C, et al. Effect of preoperative endoscopic biliary drainage on infectious morbidity after pancreatoduodenectomy: a case-control study. Am J Surg. 2008;195:442–6.PubMedCrossRef
18.
Mezhir JJ, Brennan MF, Baser RE, et al. A matched case-control study of preoperative biliary drainage in patients with pancreatic adenocarcinoma: routine drainage is not justified. J Gastrointest Surg. 2009;13:2163–9.PubMedCrossRef
19.
Mizuno T, Ishizaki Y, Komuro Y, et al. Surgical treatment of abdominal wall tumor seeding after percutaneous transhepatic biliary drainage. Am J Surg. 2007;193:511–3.PubMedCrossRef
20.
Bonin EA, Baron TH. Preoperative biliary stents in pancreatic cancer. J Hepatobiliary Pancreat Sci. 2011;18:621–9.PubMedCrossRef
21.
Beger HG, Birk D, Bodner E, et al. Is histological verification of pancreatic carcinoma a prerequisite for pancreatic resection? Langenbecks Arch Surg. 1995;380:62–6.
22.
Hartwig W, Schneider L, Diener MK, et al. Preoperative tissue diagnosis for tumours of the pancreas. Br J Surg. 2009;96:5–20.PubMedCrossRef
23.
Yun SS, Remotti H, Vazquez MF, et al. Endoscopic ultrasound-guided biopsies of pancreatic masses: comparison between fine needle aspirations and needle core biopsies. Diagn Cytopathol. 2007;35:276–82.PubMedCrossRef
24.
Aithal GP, Anagnostopoulos GK, Tam W, et al. EUS-guided tissue sampling: comparison of dual sampling with sequential sampling. Endoscopy. 2007;39:725–30.PubMedCrossRef
25.
Binmoeller KF, Thul R, Rathod V, et al. Endoscopic ultrasound-guided, 18-gauge, fine needle aspiration biopsy of the pancreas using a 2.8 mm channel convex array echoendoscope. Gastrointest Endosc. 1998;47:121–7.PubMedCrossRef
26.
Eloubeidi MA, Varadarajulu S, Desai S, et al. A prospective evaluation of an algorithm incorporating routine preoperative endoscopic ultrasound-guided fine needle aspiration in suspected pancreatic cancer. J Gastrointest Surg. 2007;11:813–9.PubMedCrossRef
27.
Krishna NB, Tummala P, Mehan CD, et al. Small and potentiall resectable focal pancreatic lesions noted on CT/MRI scans in nonjaundiced patients: likelihood of neoplasia and utility of EUS. J Gastrointest Surg. 2012;16:793–800.PubMedCrossRef
28.
Meining A, Rösch T, Wolf A, et al. High interobserver variability in endosonographic staging of upper gastrointestinal cancers. Z Gastroenterol. 2003:41:391–4.PubMedCrossRef
29.
Gleeson FC, Kipp BR, Caudill JL, et al. False positive endoscopic ultrasound fine needle aspiration cytology: incidence and risk factors. Gut. 2010;59:586–93.PubMedCrossRef
30.
Targarona EM, Pera M, Martinez J, et al. Laparoscopic treatment of pancreatic disorders: diagnosis and staging, palliation of cancer and treatment of pancreatic pseudocysts. Int Surg. 1996;81:1–5.PubMed
31.
Minnard EA, Conlon KC, Hoos A, et al. Laparoscopic ultrasound enhances standard laparoscopy in the staging of pancreatic cancer. Ann Surg. 1998;228:182–7.PubMedCentralPubMedCrossRef
32.
Tapper E, Kalb B, Martin Dr, et al. Staging laparoscopy for proximal pancreatic cancer in a magnetic resonance imaging-driven practice: what’s it worth? HPB (Oxford). 2011;13:732–7.PubMedCentralPubMedCrossRef
33.
Königsrainer I, Zieker D, Symons S, et al. Do patient- and tumor-related factors predict the peritoneal spread of pancreatic adenocarcinoma? Surg Today. 2014;44:260–3.
34.
van Gulik TM, Reeders JW, Bosma A, et al. Incidence and clinical findings of benign, inflammatory disease in patients resected for presumed pancreatic head cancer. Gastrointest Endosc. 1997;46:417–23.PubMedCrossRef
35.
Smith CD, Behrns KE, van Heerden JA, et al. Radical pancreatoduodenectomy for misdiagnosed pancreatic mass. Br J Surg 1994;81:585–9.PubMedCrossRef
36.
Abraham SC, Wilentz RE, Yeo CJ, et al. Pancreaticoduodenectomy (Whipple resections) in patients without malignancy. Am J Surg Pathol. 2003;27:110–20.PubMedCrossRef
37.
Gangl O, Fröschl U, Hofer W, et al. Unplanned reoperation and reintervention after pancreatic resections: an analysis of risk factors. World J Surg. 2011;35:2306–14.PubMedCrossRef
38.
Winter JM, Brennan MF, Tang LH, et al. Survival after resection of pancreatic adenocarcinoma: results from a single institution over three decades. Ann Surg Oncol. 2012;19:169–75.PubMedCrossRef
39.
Gangl O, Sahora K, Kornprat P, et al. Preparing for prospective clinical trials: a National Initiative of an Excellency Registry for Consecutive Pancreatic Cancer Resections. World J Surg. 2013. Epub ahead of print.
40.
Jensen RT, Cadiot G, Brandi ML, et al. ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms: functional pancreatic endocrine tumor syndromes. Neuroendocrinology. 2012;95:98–119.
41.
Falconi M, Bartsch DK, Eriksson B, et al. ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms of the digestive system: well-differentiated pancreatic non-functioning tumors. Neuroendocrinology. 2012;95:120–34.PubMedCrossRef
42.
Pavel M, Baudin E, Couvelard A, et al. ENETS consensus guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut and unknown primary. Neuroendocrinology. 2012;95:157–76.
Metadaten
Titel
Clinical approach to the patient with a solid pancreatic mass
verfasst von
Prof. Dr. Reinhold Függer
Odo Gangl
Uwe Fröschl
Publikationsdatum
01.02.2014
Verlag
Springer Vienna
Erschienen in
Wiener Medizinische Wochenschrift / Ausgabe 3-4/2014
Print ISSN: 0043-5341
Elektronische ISSN: 1563-258X
DOI
https://doi.org/10.1007/s10354-014-0266-0

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