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Zentralbl Chir 2010; 135(3): 210-217
DOI: 10.1055/s-0030-1247352
Übersicht

© Georg Thieme Verlag Stuttgart ˙ New York

Diagnostik und operative Therapie des Gastrinoms, Vipoms, Glukagonoms, Somatostatinoms und nichtfunktioneller endokriner Pankreastumoren

Diagnosis and Surgical Management of Neureondocrine Pancreatic TumoursV. Fendrich1 , D. K. Bartsch1
  • 1Universitätsklinikum Gießen und Marburg, Klinik für Visceral-, Thorax- und Gefäßchirurgie, Marburg, Deutschland
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Publication History

Publication Date:
14 June 2010 (online)

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Zusammenfassung

Die einzige Möglichkeit, Patienten mit neuroendokrinen Pankreastumoren (NPTs) dauerhaft zu heilen, besteht in der kompletten chirurgischen Entfernung des Primarius, aber auch von Rezidiven und eventuell vorhandener Lymphknoten- oder Fernmetastasen. Dieser Grundsatz gilt sowohl für Gastrinome, Vipome, Glukagonome, Somatostatinome als auch die nicht-funktionellen NPTs. Durch einen aggressiven chirurgischen Therapieansatz kann neben einer dauerhaften Heilung von Patienten mit benignen NPTs ein Langzeitüberleben bei Patienten mit malignen NPTs erzielt werden.

Abstract

The only chance of cure for patients with pancreatic endocrine tumours (PETs) is complete surgical removal not only of the primary tumour, but also of local or distant metastases. This is true for gastrinomas, vipomas, glucagonomas, somatostatinomas and non-functional pancreatic endocrine tumours. An aggressive surgical approach leads to cure in patients with benign tumours, and may achieve long-term survival in patients with malignant NPTs.

Schlüsselwörter

Pankreastumor - endokrine Chirurgie - Pankreaschirurgie

Key words

pancreatic tumours - endocrine surgery - pancreatic surgery

Literatur

  • 1 Öberg K, Eriksson B. Endocrine tumors of the pancreas.  Best Pract Res Clin Gastroenterol. 2005;  19 753-781
    CrossrefPubMedGoogle Scholar
  • 2 Fendrich V, Habbe N, Celik I et al. Operative Therapie und Langzeitüberleben bei neuroendokrinen Pankreastumoren Erfahrungen bei 144 Patienten.  Dtsch Med Wochenschr. 2007;  13 195-200
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Bartsch D K, Schilling T, Ramaswamy A et al. Management of nonfunctioning islet cell carcinomas.  World J Surg. 2000;  24 1418-1424
    CrossrefPubMedGoogle Scholar
  • 4 Fendrich V, Bartsch D K, Langer P et al. Zollinger-Ellison-Syndrom – Das gewandelte Verständnis der Chirurgie.  Chirurg. 2005;  76 217-226
    CrossrefPubMedGoogle Scholar
  • 5 Yu F, Venzon D J, Serrano J et al. Prospective study of the clinical course, prognostic factors, causes of death, and survival in patients with long-standing Zollinger-Ellison syndrome.  J Clin Oncol. 1999;  17 615-630
    PubMedGoogle Scholar
  • 6 Weber H C, Venzon D J, Lin T J et al. Determinants of metastatic rate and survival in patients with Zollinger-Ellison syndrome: A prospective long-term study.  Gastroenterology. 1995;  108 1637-1649
    CrossrefPubMedGoogle Scholar
  • 7 Metz D C, Jensen R T. Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors.  Gastroenterology. 2008;  135 1469-1492
    CrossrefPubMedGoogle Scholar
  • 8 Roy P K, Venzon D J, Shojamanesh H et al. Zollinger-Ellison syndrome. Clinical presentation in 261 patients.  Medicine. 2000;  79 379-411
    CrossrefPubMedGoogle Scholar
  • 9 Jensen R T, Gardner J D. Gastrinoma. In: Go VLW, Di Magno EP, Gardner JD, eds. The Pancreas: Biology, Pathobiology and Disease, 2nd ed. New York: Raven Press; 1993: 931
    PubMedGoogle Scholar
  • 10 Dhillo W S, Jayasena C N, Lewis C J et al. Plasma gastrin measurement cannot be used to diagnose a gastrinoma in patients on either proton pump inhibitors or histamine type-2 receptor antagonists.  Ann Clin Biochem. 2006;  43 153-155
    CrossrefPubMedGoogle Scholar
  • 11 Berna M J, Hoffmann K M, Long S H et al. Serum gastrin in Zollinger-Ellison syndrome: II. Prospective study of gastrin provocative testing in 293 patients from the National Institutes of Health and comparison with 537 cases from the literature. evaluation of diagnostic criteria, proposal of new criteria, and correlations with clinical and tumoral features.  Medicine (Baltimore). 2006;  85 331-364
    CrossrefPubMedGoogle Scholar
  • 12 Norton J A, Cornelius M J, Doppman J L et al. Effect of parathyroidectomy in patients with hyperparathyroidism, Zollinger-Ellison syndrome, and multiple endocrine neoplasia type I: a prospective study.  Surgery. 1987;  102 958-966
    PubMedGoogle Scholar
  • 13 Frucht H, Howard J M, Slaff J et al. Secretin and calcium provocative tests in the Zollinger-Ellison syndrome. A prospective study.  Ann Intl Med. 1989;  111 713-722
    PubMedGoogle Scholar
  • 14 Wada M, Komoto I, Doi R et al. Intravenous calcium injection test is a novel complementary procedure in differential diagnosis for gastrinoma.  World J Surg. 2002;  26 1291-1296
    CrossrefPubMedGoogle Scholar
  • 15 Kouvaraki M A, Solorzano C C, Shapiro S E et al. Surgical treatment of non-functioning pancreatic islet cell tumors.  J Surg Oncol. 2005;  89 170-185
    CrossrefPubMedGoogle Scholar
  • 16 Bajetta E, Ferrari L, Martinetti A et al. Chromogranin A, neuron specific enolase, carcinoembryonic antigen, and hydroxyindole acetic acid evaluation in patients with neuroendocrine tumors.  Cancer. 1999;  86 858-865
    CrossrefPubMedGoogle Scholar
  • 17 Langer P, Wild A, Hall A et al. Prevalence of multiple endocrine neoplasia type 1 in young patients with apparently sporadic primary hyperparathyroidism or pancreaticoduodenal endocrine tumours.  Br J Surg. 2003;  90 1599-1603
    CrossrefPubMedGoogle Scholar
  • 18 Stabile B E, Morrow D J, Passaro E. The gastrinoma triangle: Operative implications.  Am J Surg. 1984;  147 25-31
    CrossrefPubMedGoogle Scholar
  • 19 Sugg S L, Norton J A, Fraker D L et al. A prospective study of intraoperative methods to find and resect duodenal gastrinomas.  Ann Surg. 1993;  218 138-144
    CrossrefPubMedGoogle Scholar
  • 20 Zogakis T G, Gibril F, Libutti S K et al. Management and outcome of patients with sporadic gastrinoma arising in the duodenum.  Ann Surg. 2003;  238 42-48
    CrossrefPubMedGoogle Scholar
  • 21 Norton J A, Fraker D L, Alexander H R et al. Surgery to cure the Zollinger-Ellison syndrome.  N Engl J Med. 1999;  341 635-644
    CrossrefPubMedGoogle Scholar
  • 22 Zimmer T, Scherübl H, Faiss S et al. Endoscopic ultrasonography of neuroendocrine tumors.  Digestion. 2000;  62 Suppl 1 45-50
    CrossrefPubMedGoogle Scholar
  • 23 Anderson M A, Carpenter S, Thompson N W et al. Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas.  Am J Gastroenterol. 2000;  95 2271-2277
    CrossrefPubMedGoogle Scholar
  • 24 Rothmund M, Angelini L, Brunt M et al. Surgery for benign insulinoma: an international review.  World J Surg. 1990;  14 393-399
    CrossrefPubMedGoogle Scholar
  • 25 Norton J A, Jensen R T. Resolved and unresolved controversies in the surgical management of patients with Zollinger-Ellison syndrome.  Ann Surg. 2004;  240 757-773
    CrossrefPubMedGoogle Scholar
  • 26 Noone T C, Hosey J, Firat Z et al. Imaging and localization of islet-cell tumors of the pancreas on CT and MRI.  Best Pract Res Clin Endocrinol Metab. 2005;  2 195-211
    PubMedGoogle Scholar
  • 27 Virgolini I, Traub-Weidinger T, Decristoforo C. Nuclear medicine in the detection and management of pancreatic islet-cell tumors.  Best Pract Res Clin Endocrinol Metab. 2005;  2 213-227
    PubMedGoogle Scholar
  • 28 Skogseid B, Oberg K, Akerstrom G et al. Limited tumor involvement found at multiple endocrine neoplasia type I pancreatic exploration: can it be predicted by preoperative tumor localization?.  World J Surg. 1998;  22 673-677
    CrossrefPubMedGoogle Scholar
  • 29 Langer P, Kann P H, Fendrich V et al. Prospective Evaluation of Imaging Procedures for the Detection of Pancreaticoduodenal Endocrine Tumors in Patients with Multiple Endocrine Neoplasia Type 1.  World J Surg. 2004;  28 1317-1322
    CrossrefPubMedGoogle Scholar
  • 30 Norton J A, Fraker D L, Alexander H R et al. Surgery increases survival in patients with gastrinoma.  Ann Surg. 2006;  244 410-419
    PubMedGoogle Scholar
  • 31 Fendrich V, Langer P, Waldmann J et al. The management of sporadic and von Hippel endocrine neoplasia type 1 gastrinomas.  Br J Surg. 2007;  94 1331-1341
    CrossrefPubMedGoogle Scholar
  • 32 Anlauf M, Enosawa T, Henopp T et al. Primary lymph node gastrinoma or occult duodenal microgastrinoma with lymph node metastases in a MEN1 patient: the need for a systematic search for the primary tumor.  Am J Surg Pathol. 2008;  32 1101-1105
    CrossrefPubMedGoogle Scholar
  • 33 Mignon M, Ruszniewski P, Podevin P et al. Current approach to the management of a gastrinoma and insulinoma in adults with multiple endocrine neoplasia I.  World J Surg. 1993;  17 489-495
    CrossrefPubMedGoogle Scholar
  • 34 Fendrich V, Waldmann J, Bartsch D K et al. Surgical management of pancreatic endocrine tumors.  Nat Rev Clin Oncol. 2009;  6 419-428
    CrossrefPubMedGoogle Scholar
  • 35 Skogseid B, Oberg K, Akerstrom G et al. Limited tumor involvement found at multiple endocrine neoplasia type I pancreatic exploration: can it be predicted by preoperative tumor localization?.  World J Surg. 1998;  22 673-670
    CrossrefPubMedGoogle Scholar
  • 36 Thompson N W. Management of pancreatic endocrine tumors in patients with multiple endocrine neoplasia type 1.  Surg Clin N Am. 1998;  7 881-891
    PubMedGoogle Scholar
  • 37 Bartsch D K, Fendrich V, Langer P et al. Outcome of duodenopancreatic resections in patients with multiple endocrine neoplasia type 1.  Ann Surg. 2005;  242 757-764 ,  discussion 764–766
    CrossrefPubMedGoogle Scholar
  • 38 Tonelli F, Fratini G, Nesi G et al. Pancreatectomy in multiple endocrine neoplasia type 1-related gastrinomas and pancreatic endocrine neoplasias.  Ann Surg. 2006;  244 61-70
    CrossrefPubMedGoogle Scholar
  • 39 Imamura M, Komoto I, Doi R et al. New pancreas-preserving total duodenectomy technique.  World J Surg. 2005;  29 203-207
    CrossrefPubMedGoogle Scholar
  • 40 El Rassi Z S, Ferdinand L, Mohsine R M et al. Primary and second endocrine liver tumors: clinical presentation, surgical approach and outcome.  Hepatogastroenterology. 2002;  49 1340-1346
    PubMedGoogle Scholar
  • 41 Lo C Y, van Heerden J A, Thompson G B et al. Islet cell carcinomas of the pancreas.  World J Surg. 1996;  20 878-884
    CrossrefPubMedGoogle Scholar
  • 42 Solorzano C C, Lee J E, Pisters P TW et al. Nonfunctioning islet cell carcinoma of the pancreas: Survival results in a contemporary series of 163 patients.  Surgery. 2001;  130 1078-1085
    CrossrefPubMedGoogle Scholar
  • 43 Fendrich V, Langer P, Celik I et al. An aggressive surgical approach leads to long-term survival in patients with pancreatic endocrine tumors.  Ann Surg. 2006;  244 845-851 ,  discussion 852–853
    CrossrefPubMedGoogle Scholar
  • 44 Tran K T, Smeenk H G, van Eijck C HJ et al. Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure. A prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors.  Ann Surg. 2004;  240 738-745
    CrossrefPubMedGoogle Scholar
  • 45 Lowney J K, Frisella M M, Lairmore T C et al. Pancreatic islet cell tumor metastasis in multiple endocrine neoplasia type 1: correlation with primary tumor size.  Surgery. 1999;  125 1043-1049
    PubMedGoogle Scholar
  • 46 Akerstrom G, Hessman O, Skogseid B. Timing and extent of surgery in symptomatic and asymptomatic neuroendocrine tumors of the pancreas in MEN1.  Langenbecks Arch Surg. 2002;  386 558-569
    CrossrefPubMedGoogle Scholar
  • 47 Fernandez-Cruz L, Cesar-Borges G. Laparoscopic strategies for resection of insulinomas.  J Gastrointest Surg. 2006;  10 752-760
    CrossrefPubMedGoogle Scholar
  • 48 Carrere N, Abid S, Julio C H et al. Spleen-preserving distal pancreatectomy with excision of splenic artery and vein: a case-matched comparison with conventional distal pancreatectomy with splenectomy.  World J Surg. 2007;  31 375-382
    CrossrefPubMedGoogle Scholar
  • 49 Hesse U. Die laparoskopische Pankreasresektion.  Zentralbl Chir. 2006;  131 162-166
    Article in Thieme ConnectPubMedGoogle Scholar
  • 50 Bärlehner E, Anders S, Schwetling R. Die laparoskopische Pankreaslinksresektion bei Tumoren.  Zentralbl Chir. 2001;  126 482-485
    Article in Thieme ConnectPubMedGoogle Scholar

Dr. Volker Fendrich

Universitätsklinikum Gießen und Marburg · Klinik für Visceral-, Thorax- und Gefäßchirurgie

Baldingerstraße

35033 Marburg

Deutschland

Phone: 00 49 / 64 21 / 5 86 65 44

Fax: 00 49 / 64 21 / 5 86 65 44

Email: fendrich@med.uni-marburg.de

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