Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2014 May 30;111(22):396-402.
doi: 10.3238/arztebl.2014.0396.

Ductal pancreatic adenocarcinoma

Thomas Seufferlein  1 , Marc Porzner, Volker Heinemann, Andrea Tannapfel, Martin Stuschke, Waldemar Uhl
Affiliations
Review

Ductal pancreatic adenocarcinoma

Thomas Seufferlein et al. Dtsch Arztebl Int. .

Abstract

Background: Ductal adenocarcinoma of the pancreas is the fourth most common cause of death from cancer in men and women in Germany: about 15 000 persons die of this disease each year.

Method: The S3 guideline on exocrine pancreatic carcinoma was updated with the aid of systematic literature reviews on the surgical, neoadjuvant, and adjuvant treatment of ductal pancreatic carcinoma, and on treatment in the metastatic stage. These reviews covered the periods 2002 to February 2012 (for radiotherapy) and 2006 to August 2011 (for all other topics).

Results: The criteria for borderline resectable pancreatic tumors are the same as those of the guidelines of the National Comprehensive Cancer Network. Preoperative biliary drainage with a stent is recommended only if cholangitis is present or if a planned operation cannot be performed soon after the diagnosis is made. When a pancreatic carcinoma is resected, at least 10 regional lymph nodes should be excised, and the ratio of affected to excised nodes should be documented in the pathology report. Gemcitabine and 5-fluorouracil are recommended for adjuvant therapy. Neither of these drugs is preferred over the other; if the one initially given is poorly tolerated, the other one should be given instead. When gemcitabine and erlotinib are given for palliative treatment, erlotinib should be given for no longer than 8 weeks if no skin rash develops. In selected patients, the folfirinox protocol yields markedly better results than gemcitabin. Moreover, the new combination of nab-paclitaxel and gemcitabine can be used as first-line treatment. In the event of disease progression under first-line treatment, second-line treatment should be initiated.

Conclusion: In recent years, new chemotherapeutic protocols have brought about marked improvement in palliative care. Further trials are needed to determine whether the perioperative or adjuvant use of these protocols might also improve the outcome of surgical treatment with curative intent.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram of the systematic literature search (aggregated evidence and primary sources)
Figure 2
Figure 2
Resection margin—Moderately differentiated ductal adenocarcinoma of the pancreas; the resection margin is marked in blue. The distance of the tumor from the resection margin should be measured under the microscope and documented in the pathology report. Hematoxylin-eosin (H&E;) stain, distance scale in figure
Figure 3
Figure 3
Perineurial infiltration—Tumor cells of pancreatic adenocarcinoma are seen in a nerve in the peripancreatic fat. H&E; stain, distance scale in figure
See this image and copyright information in PMC

Comment in

  • Ultrasound-based therapies not mentioned.
    Marinova M, Rauch M, Strunk H. Marinova M, et al. Dtsch Arztebl Int. 2015 Jan 23;112(4):60. doi: 10.3238/arztebl.2015.0060a. Dtsch Arztebl Int. 2015. PMID: 25797427 Free PMC article. No abstract available.
  • In reply.
    Seufferlein T. Seufferlein T. Dtsch Arztebl Int. 2015 Jan 23;112(4):60. doi: 10.3238/arztebl.2015.0060b. Dtsch Arztebl Int. 2015. PMID: 25797428 Free PMC article. No abstract available.

References

    1. Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V., R.-K.-I., Krebs in Deutschland 2009/2010. ed. Robert Koch-Institut. Vol. 9. Berlin: Robert Koch-Institut; 2013. Gesundheitsberichterstattung des Bundes.
    1. Seufferlein T, Porzner M, Becker T, et al. S3-guideline exocrine pancreatic cancer. Z Gastroenterol. 2013;51:1395–1440. - PubMed
    1. Doi R, Imamura M, Hosotani R, et al. Surgery versus radiochemotherapy for resectable locally invasive pancreatic cancer: final results of a randomized multi-institutional trial. Surg Today. 2008;38:1021–1028. - PubMed
    1. Satoi S, Yanagimoto H, Toyokawa H, et al. Selective use of staging laparoscopy based on carbohydrate antigen 19-9 level and tumor size in patients with radiographically defined potentially or borderline resectable pancreatic cancer. Pancreas. 2011;40:426–432. - PubMed
    1. Hariharan D, Constantinides VA, Froeling FE, Tekkis PP, Kocher HM. The role of laparoscopy and laparoscopic ultrasound in the preoperative staging of pancreatico-biliary cancers-A meta-analysis. Eur J Surg Oncol. 2010;36:941–948. - PubMed

MeSH terms