Dokument: Das Mesopankreas und die periampullären Karzinome
| Titel: | Das Mesopankreas und die periampullären Karzinome | |||||||
| Weiterer Titel: | The mesopancreas and the periampullary carcinomas | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=66941 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20241014-074104-4 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Rug, Falko [Autor] | |||||||
| Dateien: |
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| Beitragende: | Dr. med. habil Safi, Sami Alexander [Gutachter] Univ.-Prof. Dr. med. Irene Esposito [Gutachter] | |||||||
| Stichwörter: | Mesopankreas, periampulläre Karzinome, Gallengangskrebs, ampulläres Karzinom, peripankreatisches Fettgewebe, LEEPP, Cholangiokarzinom, CRM, Mesopancreas, periampullary carcinomas, bile duct cancer, ampullary carcinoma, peripancreatic adipose tissue, cholangiocarcinoma | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Die periampullären Karzinome beinhalten eine Vielzahl von verschiedenen Karzinomen in und um die Ampulla Vateri. Die häufigsten zwei Formen sind die distalen Gallengangskarzinome (dCCC) und die Papillenkarzinome (PC). Die Diagnosestellung erfolgt meistens im fortgeschrittenen Stadium, wenn aufgrund einer Obstruktion der Gallengänge Symptome ausgelöst werden. Die chirurgische Therapie dieser Karzinomgruppen ist die partielle Pankreatoduodenektomie. Die mesopankreatische (MP) Exzision ist ein anatomisch geprägter chirurgischer Ansatz, welcher für das pankreatische duktale Adenokarzinom (PDAC) bereits studiert wurde. Die Implementierung des pathologischen circumferentiellen Resektionsrandes (CRM) zeigt für das PDAC eine unterschätzte Tumorausdehnung, vor allem im dorsalen Resektionsrand, welcher das Mesopankreas beinhaltet. Das Ziel dieser Arbeit ist es, den MP Raum an periampullären Karzinomen mit Blick auf eine vorhandenen Tumorinfiltration durch das jeweilige Karzinom zu studieren. Aus einer konsekutiv therapierten Patientenkohorte wurden die histopathologischen Berichte von Patientinnen und Patienten mit einem periampullären Karzinom in Hinblick auf eine Tumorinfiltration des MP Fettgewebes reevaluiert. Es wurden 91 Patienten mit einem periampullären Karzinom eingeschlossen (50 Patienten mit einem Papillenkarzinom (PC) und 41 mit einem distalen Gallengangskarzinom (dCCC)). Der MP-Infiltrationsstatus bei Patienten mit einem PC oder dCCC war signifikant höher in Patienten mit einer L1-Situation oder synchroner Pankreasparenchyminfiltration. Zusätzlich bestand bei PC-Patienten ein signifikanter Zusammenhang zwischen der MP-Infiltration und einem Tumorstadium ≥T3 oder einer V1-Situation. Die Rate an MP Infiltration war nur in PC-Patienten signifikant geringer, im Vergleich zu dCCC und PDAC-Patienten. Dies ist die erste Studie, welche das Mesopankreas in periampullären Karzinome analysiert hat. Es lässt sich schlussfolgern, dass die mesopankreatische Resektion während der Pankreatoduodenektomie notwendig ist, um eine vollständige chirurgische Resektion dieser Tumoren zu gewährleisten. Weitere multizentrische Studien sind nötig, um die onkologische Relevanz des Mesopankreas in periampullären Karzinome zu studieren.Periampullary carcinomas include a variety of different carcinomas in and around the ampulla of Vater. The two most common forms are distal bile duct carcinoma (dCCC) and papillary carcinoma (PC). These are only rudimentarily studied. The diagnosis is usually made at an advanced stage when symptoms are triggered due to an obstruction of the bile duct. The guideline-based surgical treatment for these three carcinomas is partial pancreatoduodenectomy. Mesopancreatic excision is an anatomically based surgical approach that has already been studied for pancreatic ductal adenocarcinoma (PDAC). The implementation of the pathological circumferential resection margin (CRM) shows an underestimated tumor extent for PDAC, especially in the dorsal resection margin. The aim of this work is to study tumor infiltration of the mesopancreas in periampullary carcinomas. From a consecutively treated cohort of patients, the histopathological reports of patients with dCCC and PC were reevaluated regarding tumor infiltration of the mesopancreatic fatty tissue (MP).
91 patients with periampullary carcinoma were included (50 papillary carcinomas (PC) and 41 distal cholangiocarcinomas (dCCC)). The MP infiltration status in patients with a PC or dCCC was significantly higher in patients with a L1-situation or synchronous pancreatic parenchymal infiltration by the respective tumor. In addition, there was a significant association between MP infiltration and tumor stage ≥T3 or V1-status in PC patients. Only PC patients showed a significantly lower rate of mesopancreatic fat infiltration, when compared to dCCC and PDAC patients. This is the first study to analyze the mesopancreas in periampullary carcinomas. The infiltration status was particularly high in patients with dCCCs. It can be concluded that mesopancreatic resection during pancreatoduodenectomy is necessary to ensure complete surgical resection of the tumor. Further multicenter studies are needed to study the oncological relevance of the mesopancreas in periampullary carcinomas. | |||||||
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