Chronische Pankreatitis – Update Leitlinie: Eine Frage der richtigen Therapie zum richtigen Zeitpunkt

Die primären Ziele der Therapie der chronischen Pankreatitis sind das Erreichen von Schmerzfreiheit und die Vermeidung von Pankreatitis-assoziierten Komplikationen. Hier ist die chirurgische Therapie der interventionellen Behandlung im Langzeitverlauf überlegen [ 1 ], [ 2 ] . Die besten Ergebnisse werden erzielt, wenn die operative Intervention frühzeitig (innerhalb von 3 Jahren nach Diagnose) erfolgt und resezierende aber zugleich organsparende Operationsverfahren angewendet werden.

• Literatur

• 1 Cahen DL, Gouma DJ, Nio Y et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med. 2007; 356: 676-684
• 2 Cahen DL, Gouma DJ, Laramee P et al. Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patients with chronic pancreatitis. Gastroenterology. 2011; 141: 1690-1695
• 3 Hoffmeister A, Mayerle J, Beglinger C et al. Chronic Pancreatitis: S3-Consensus Guidelines on Definition, Etiology, Diagnosis and Management. German Society of Digestive and Metabolic Diseases (DGVS). Z Gastroenterol. 2012; 50: 1176-1224
• 4 Lankisch PG, Lohr-Happe A, Otto J et al. Natural course in chronic pancreatitis. Pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease. Digestion. 1993; 54: 148-155
• 5 Strobel O, Buchler MW, Werner J. Surgical therapy of chronic pancreatitis: indications, techniques and results. Int J Surg. 2009; 7: 305-312
• 6 Ahmed Ali U, Nieuwenhuijs VB, van Eijck CH et al. Clinical outcome in relation to timing of surgery in chronic pancreatitis: a nomogram to predict pain relief. Arch Surg. 2012; 147: 925-932
• 7 Hoffmeister A, Mayerle J, Beglinger C 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. 2012; 50: 1176-1224
• 8 Partington PF, Rochelle RE. Modified Puestow procedure for retrograde drainage of the pancreatic duct. Ann Surg. 1962; 152 p. 1037-1043
• 9 Ueda J, Tanaka M, Ohtsuka T et al. Surgery for chronic pancreatitis decreases the risk for pancreatic cancer: a multicenter retrospective analysis. Surgery. 2013; 153: 357-364
• 10 Traverso LW, Longmire Jr. WP. Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet. 1978; 146: 959-962
• 11 Diener MK, Rahbari NN, Fischer L et al. Duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for surgical treatment of chronic pancreatitis: a systematic review and meta-analysis. Ann Surg. 2008; 247: 950-961
• 12 Beger HG, Büchler M, Bittner R. The duodenum preserving resection of the head of the pancreas (DPRHP) in patients with chronic pancreatitis and an inflammatory mass in the head. An alternative surgical technique to the Whipple operation. Acta Chir Scand. 1990; 156: 309-315
• 13 Gloor B, Friess H, Uhl W et al. A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis. Dig Surg. 2001; 18 p. 21-25
• 14 Bockhorn M, Gebauer F, Bogoevski D et al. Chronic pancreatitis complicated by cavernous transformation of the portal vein: contraindication to surgery?. Surgery. 2011; 149: 321-328
• 15 Bachmann K, Tomkoetter L, Kutup A et al. Is the Whipple procedure harmful for long-term outcome in treatment of chronic pancreatitis? 15-years follow-up comparing the outcome after pylorus-preserving pancreatoduodenectomy and Frey procedure in chronic pancreatitis. Ann Surg. 2013; 258: 815-820 ; discussion 820–821
• 16 Diener MK, Bruckner T, Contin P et al. ChroPac-trial: duodenum-preserving pancreatic head resection versus pancreatoduodenectomy for chronic pancreatitis. Trial protocol of a randomised controlled multicentre trial. Trials. 2010; 11: 47
• 17 Chinnakotla S, Beilman GJ, Dunn TB et al. Factors Predicting Outcomes After a Total Pancreatectomy and Islet Autotransplantation Lessons Learned From Over 500 Cases. Ann Surg. 2015; 262: 610-622