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Spezielle Resektionstechniken der Pankreaschirurgie

Artery-first‑, Uncinate-first- und Triangle-Operation

Special Resection Techniques for Pancreatic Surgery

Artery First, Uncinate First, and Triangle Operation

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Journal für Gastroenterologische und Hepatologische Erkrankungen Aims and scope

Zusammenfassung

Chirurgische Eingriffe am Pankreas stellen anspruchsvolle Operationen dar, die nach wie vor mit einer relevanten Morbidität verbunden sind, wogegen die Mortalität in den vergangenen Jahrzehnten in spezialisierten Zentren auf unter 5 % gesunken ist. Dies erklärt sich einerseits durch verbesserte Operationstechniken, andererseits durch die interdisziplinäre Therapie von postoperativen Komplikationen. Gleichzeitig wurden die Indikationen zur Pankreasresektion kontinuierlich ausgeweitet, insbesondere bei der Chirurgie von malignen Tumoren stellen heute erweiterte Resektionstechniken Standardvorgehen dar. In diesem Kontext spielt auch die neoadjuvante Therapie mit anschließender Resektion eine zentrale Rolle, um einerseits die Resektabilität als solche, aber auch das onkologische Ergebnis zu verbessern. In dieser Übersichtsarbeit werden spezielle Techniken der Pankreaschirurgie, die sog. „Artery-first-“ und „Uncinate first-Techniken“ sowie die „Triangle-Operation“, dargestellt.

Abstract

Pancreatic operations are complex surgical procedures that are still associated with a relevant morbidity, whereas mortality has decreased below 5% in specialized centers during recent decades. On the one hand, this is explained by improved surgical techniques; on the other hand, interdisciplinary management of postoperative complications has significantly contributed to this development. Parallel to this, indications for pancreatic resections have been continuously pushed forward, especially with regard to approaches in pancreatic cancer surgery and extended resection techniques can be regarded as standard procedures today. Furthermore, neoadjuvant treatment concepts with consecutive resection play a major role today to improve resectability as well as oncological outcome for the respective patients. In this review, special surgical approaches for pancreatic cancer resection, i.e., the so-called artery first and uncinate first approaches as well as the triangle operation, are summarized.

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  1. Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    Thilo Hackert

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Correspondence to Thilo Hackert.

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T. Hackert gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Hackert, T. Spezielle Resektionstechniken der Pankreaschirurgie. J. Gastroenterol. Hepatol. Erkr. 16, 121–127 (2018). https://doi.org/10.1007/s41971-018-0036-8

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