Duodenaladenome und -karzinome: chirurgische Therapiekonzepte

Tumoren des Duodenums sind selten und meist Zufallsbefunde der Gastroskopie. Neben den rein benignen Läsionen stellen Veränderungen epithelialen Ursprungs eine relevante Gruppe aufgrund ihres Entartungspotenzials mit dann schlechter Prognose für den Patienten dar. In der Folge sollen diese mit besonderem Schwerpunkt auf den Therapieoptionen beschrieben werden.

Kernaussagen

• Tumoren des Duodenums sind selten.

• Zu den häufigsten Tumoren des Duodenums zählen GIST, NET oder Adenome.

• Die Abklärung des Duodenums bei Patienten mit „Polyposis-Erkrankungen“ ist obligat.

• Die Abtragung von duodenalen Tumoren sollte primär endoskopisch erfolgen.

• Die Lokalisation der Adenome wird in papillär und nicht papillär unterschieden.

• Malignitätsverdacht, inkomplette Abtragung oder technische Gründe sprechen für eine chirurgische Therapie.

• Bei gutartigen Befunden orientiert sich das chirurgische Verfahren an der Lage des Prozesses.

• Bei Malignomverdacht ist die Pankreaskopfresektion indiziert.

• Eine regelmäßige Nachsorge ist nach Resektion gutartiger Befunde indiziert.

Schlüsselwörter

Duodenaladenome - Duodenalkarzinome - ampulläre Adenome - nicht ampulläre Adenome - Therapieoptionen

Publication History

Article published online:
30 November 2022

• Literatur

• 1 Culver EL, McIntyre AS. Sporadic duodenal polyps: classification, investigation, and management. Endoscopy 2011; 43: 144-155
• 2 Jepsen JM, Persson M, Jacobsen NO. et al. Prospective study of prevalence and endoscopic and histopathologic characteristics of duodenal polyps in patients submitted to upper endoscopy. Scand J Gastroenterol 1994; 29: 483-487
• 3 Domenech-Ximenos B, Juanpere S, Serra I. et al. Duodenal tumors on cross-sectional imaging with emphasis on multidetector computed tomography: a pictorial review. Diagn Interv Radiol 2020; 26: 193-199
• 4 Barat M, Dohan A, Dautry R. et al. Mass-forming lesions of the duodenum: A pictorial review. Diagn Interv Imaging 2017; 98: 663-675
• 5 Zhang Y, Shi XJ, Zhang XC. et al. Primary duodenal tuberculosis misdiagnosed as tumor by imaging examination: A case report. World J Clin Cases 2020; 8: 6537-6545
• 6 Gao YP, Zhu JS, Zheng WJ. Brunnerʼs gland adenoma of duodenum: a case report and literature review. World J Gastroenterol 2004; 10: 2616-2617
• 7 Bilimoria KY, Bentrem DJ, Wayne JD. et al. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann Surg 2009; 249: 63-71
• 8 Miettinen M, Kopczynski J, Makhlouf HR. et al. Gastrointestinal stromal tumors, intramural leiomyomas, and leiomyosarcomas in the duodenum: a clinicopathologic, immunohistochemical, and molecular genetic study of 167 cases. Am J Surg Pathol 2003; 27: 625-641
• 9 Akazawa Y, Ueyama H, Tsuyama S. et al. Endoscopic and Clinicopathological Features of Superficial Non-Ampullary Duodenal Tumor Based on the Mucin Phenotypes. Digestion 2021; 102: 663-670
• 10 Johnson MD, Mackey R, Brown N. et al. Outcome based on management for duodenal adenomas: sporadic versus familial disease. J Gastrointest Surg 2010; 14: 229-235
• 11 Pavlovic-Markovic A, Dragasevic S, Krstic M. et al. Assessment of Duodenal Adenomas and Strategies for Curative Therapy. Dig Dis 2019; 37: 374-380
• 12 Spigelman AD, Williams CB, Talbot IC. et al. Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet 1989; 2: 783-785
• 13 Okada K, Fujisaki J, Kasuga A. et al. Sporadic nonampullary duodenal adenoma in the natural history of duodenal cancer: a study of follow-up surveillance. Am J Gastroenterol 2011; 106: 357-364
• 14 Buchbjerg T, Fristrup C, Mortensen MB. The incidence and prognosis of true duodenal carcinomas. Surg Oncol 2015; 24: 110-116
• 15 Anand U, Pandey MK, Priyadarshi RN. et al. Large Tubullo-villous Adenoma of Duodenum Presenting as Gastric Outlet Obstruction. J Clin Diagn Res 2015; 9: PD03-PDD04
• 16 Spira IA, Wolff WI. Villous tumors of the duodenum. Am J Gastroenterol 1977; 67: 63-68
• 17 Vanbiervliet G, Strijkeer M, Arvanitakis M. et al. Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53: 429-448
• 18 Vanbiervliet G, Moss A, Arvanitakis M. et al. Endoscopic management of superficial nonampullary duodenal tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53: 522-534
• 19 Suwa T, Takizawa K, Kawata N. et al. Current Treatment Strategy for Superficial Nonampullary Duodenal Epithelial Tumors. Clin Endosc 2022; 55: 15-21
• 20 Blanco-Fernández G, Rojas-Holguín A, De-Armas-Conde N. et al. Side-to-side duodenojejunostomy after resection of third and fourth duodenal portions with pancreatic preservation. Updates Surg 2020; 72: 1105-1113
• 21 Hashimoto D, Arima K, Chikamoto A. et al. Limited Resection of the Duodenum for Nonampullary Duodenal Tumors, with Review of the Literature. Am Surg 2016; 82: 1126-1132
• 22 Walsh RM, Augustin T, Aleassa EM. et al. Comparison of pancreas-sparing duodenectomy (PSD) and pancreatoduodenectomy (PD) for the management of duodenal polyposis syndromes. Surgery 2019; 166: 496-502
• 23 Ganschow P, Hackert T, Biegler M. et al. Postoperative outcome and quality of life after surgery for FAP-associated duodenal adenomatosis. Langenbecks Arch Surg 2018; 403: 93-102
• 24 di Mola FF, Panaccio P, Grottola T. et al. Transduodenal surgical ampullectomy: a procedure that requires a multidisciplinary approach. Updates Surg, 2021.
• 25 Schneider M, Büchler WW. [Ampullary neoplasms: surgical management]. Chirurg 2021; 92: 796-802
• 26 Schneider L, Contin P, Fritz S. et al. Surgical ampullectomy: an underestimated operation in the era of endoscopy. HPB (Oxford) 2016; 18: 65-71
• 27 Papalampros A, Moris D, Petrou A. et al. Non-Whipple Operations in the Management of Benign, Premalignant and Early Cancerous Duodenal Lesions. Anticancer Res 2017; 37: 1443-1452
• 28 Nappo G, Gentile D, Galvanin J. et al. Trans-duodenal ampullectomy for ampullary neoplasms: early and long-term outcomes in 36 consecutive patients. Surg Endosc 2020; 34: 4358-4368
• 29 Linn YL, Wang Z, Goh BKP. Robotic transduodenal ampullectomy: Case report and review of the literature. Ann Hepatobiliary Pancreat Surg 2021; 25: 150-154
• 30 Khan AS, Siddiqui I, Affleck A. et al. Robotic Surgery for Benign and Low-Grade Malignant Diseases of the Duodenum. Am Surg 2019; 85: 414-419
• 31 Mitchell WK, Thomas PF, Zaitoun AM. et al. Pancreas preserving distal duodenectomy: A versatile operation for a range of infra-papillary pathologies. World J Gastroenterol 2017; 23: 4252-4261
• 32 Köninger J, Friess H, Wagner M. et al. [Technique of pancreas-preserving duodenectomy]. Chirurg 2005; 76: 273-281
• 33 Imamura M, Komoto I, Doi R. et al. New pancreas-preserving total duodenectomy technique. World J Surg 2005; 29: 203-207
• 34 Jung YK, Paik SS, Choi D. et al. Transduodenal ampullectomy for ampullary tumor. Asian J Surg 2021; 44: 723-729
• 35 Hollenbach M, Abou Ali E, Auriemma F. et al. Study Protocol of the ESAP Study: Endoscopic Papillectomy vs. Surgical Ampullectomy vs. Pancreaticoduodenectomy for Ampullary Neoplasm – A Pancreas2000/EPC Study. Front Med (Lausanne) 2020; 7: 152
• 36 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF). https://www.leitlinienprogramm-onkologie.de/leitlinien/pankreaskarzinom/%22%3ehttps://www.leitlinienprogramm-onkologie.de/leitlinien/pankreaskarzinom/%3c/uri%3e
• 37 Saluja SS, Mishra PK, Kiran S. et al. Impact of lymph node staging systems in predicting outcome in patients with ampullary cancer. Ann Hepatobiliary Pancreat Surg 2020; 24: 484-495
• 38 Lee JW, Choi SB, Lim TW. et al. Prognostic value of the lymph node metastasis in patients with ampulla of Vater cancer after surgical resection. Ann Hepatobiliary Pancreat Surg 2021; 25: 90-96
• 39 Staerkle RF, Vuille-Dit-Bille RN, Soll C. et al. Extended lymph node resection versus standard resection for pancreatic and periampullary adenocarcinoma. Cochrane Database Syst Rev 2021; (01) CD011490
• 40 Netherlands Trial Registry. NTR ID NL8424. Im Internet (Stand: 02.05.2022): http://www.trialregister.nl%22%3ehttp://www.trialregister.nl
• 41 Zimmermann C, Wolk S, Aust DE. et al. The pathohistological subtype strongly predicts survival in patients with ampullary carcinoma. Sci Rep 2019; 9: 12676
• 42 Nappo G, Galvanin J, Gentile G. et al. Long-term outcomes after pancreatoduodenectomy for ampullary cancer: The influence of the histological subtypes and comparison with the other periampullary neoplasms. Pancreatology 2021; 21: 950-956
• 43 Park SH, Shin JH, Jung KU. et al. Prognostic value of carcinoembryonic antigen and carbohydrate antigen 19-9 in periampullary cancer patients receiving pancreaticoduodenectomy. Asian J Surg 2021; 44: 829-835
• 44 Moekotte AL, Malleo G, van Roessel S. et al. Gemcitabine-based adjuvant chemotherapy in subtypes of ampullary adenocarcinoma: international propensity score-matched cohort study. Br J Surg 2020; 107: 1171-1182
• 45 Bolm L, Ohrner K, Nappo G. et al. Adjuvant therapy is associated with improved overall survival in patients with pancreatobiliary or mixed subtype ampullary cancer after pancreatoduodenectomy – A multicenter cohort study. Pancreatology 2020; 20: 433-441
• 46 Neoptolemos JP, Moore MJ, Cox TF. et al. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs. observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA 2012; 308: 147-156
• 47 Chandrasegaram MD, Gill AJ, Samra J. et al. Ampullary cancer of intestinal origin and duodenal cancer – A logical clinical and therapeutic subgroup in periampullary cancer. World J Gastrointest Oncol 2017; 9: 407-415
• 48 Kamarajah SK, Bednar F, Cho CS. et al. Survival Benefit of Adjuvant Chemotherapy After Pancreatoduodenectomy for Ampullary Adenocarcinoma: a Propensity-Matched National Cancer Database (NCDB) Analysis. J Gastrointest Surg 2021; 25: 1805-1814
• 49 Patel M, Uboha NV. Treatment Approach to Adenocarcinoma of the Ampulla of Vater. Curr Treat Options Oncol 2021; 22: 103
• 50 ClinicalTrials.gov. Phase III Trial Investigating the Potential Benefit of Adjuvant Chemotherapy for Small Bowel Adenocarcinoma (BALLAD). Im Internet (Stand: 02.05.2022): https://clinicaltrials.gov/ct2/show/study/NCT02502370