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Therapie der Hyperbilirubinämie bei Patienten mit einem Pankreaskarzinom

Welches ist der effektivere Weg zur Chemotherapie?

dc.contributor.advisorGaedcke, Jochen Prof. Dr.
dc.contributor.authorSchein, Liesa-Marie
dc.date.accessioned2023-03-13T16:10:47Z
dc.date.available2023-03-29T00:50:10Z
dc.date.issued2023-03-13
dc.identifier.urihttp://resolver.sub.uni-goettingen.de/purl?ediss-11858/14569
dc.identifier.urihttp://dx.doi.org/10.53846/goediss-9783
dc.format.extentXXX Seitende
dc.language.isodeude
dc.subject.ddc610de
dc.titleTherapie der Hyperbilirubinämie bei Patienten mit einem Pankreaskarzinomde
dc.title.alternativeWelches ist der effektivere Weg zur Chemotherapie?de
dc.typedoctoralThesisde
dc.title.translatedManagement of hyperbilirubinemia in pancreatic cancerde
dc.contributor.refereePetzold, Golo PD Dr.
dc.date.examination2023-03-21de
dc.description.abstractengApproximately 18,000 patients are diagnosed with pancreatic cancer in Germany each year. Unfortunately, prognosis is still quite poor. The only curative therapy is a surgical resection of the tumor, however only about 10-20% of the patients are suitable for a surgery at the time of diagnosis. Another therapeutical option is chemotherapy, which requires a bilirubin level within the range of normal to be suitable for full dosage. Additionally, many clinical trials exclude patient with hyperbilirubinemia though a painless jaundice is one of the most common symptoms in patients with pancreatic cancer. The aim of this study was to compare the two most common therapeutical ways to treat hyperbilirubinemia: the ERCP with stent implantation versus the surgical creation of a biliodigestive anastomosis. In order to compare the latter three different goals for serum bilirubin levels within 20 days of the surgery or intervention were defined. 1) Total serum bilirubin level ≤ 1.8 mg/dl 2) Total serum bilirubin level ≤ 2.5 mg/dl 3) Total serum bilirubin level < 5.0 mg/dl A retrospective analysis of 58 patients, who fit the including criteria, was performed. There was no statistically significant difference between the surgical and the interventional group regarding the achievement of goal one (total serum bilirubin level ≤ 1.8 mg/dl) (p = 0.24) and goal two (total serum bilirubin level ≤ 2.5 mg/dl) (p = 0.20). Although more patients of the surgical group achieved the first goal (40.0% vs. 21.7%) there was also a higher rate of complications in comparison to the ERCP with stent insertion (40.0% vs. 26.1%). There were less complications when no pancreatic resection was performed during the surgery (30.0%). Statistically more patients of the ERCP group achieved a total serum bilirubin level ≤ 2.5 mg/dl when a simultaneously EPT was performed (p = 0.04) and no complications occurred (p = 0.02). The bilirubin level of goal three (total serum bilirubin level < 5.0 mg/dl) was more often achieved by patients, wo had a surgical treatment of the jaundice. This difference was statistically significant (p = 0.03) in comparison to the interventional group. Regarding the length of the hospital stay patients who had a surgical therapy of their hyperbilirubinemia were released five days later than the patients who had an ERCP with stent insertion (14 days vs. 19 days). This difference also presented to be statistically significant (p < 0.001). When there was solely a biliodigestive anastomosis performed during surgery the patients stayed significantly less days in the hospital in comparison to the one who had a pancreatic resection (13 days vs. 17 days) (p = 0.005). However the number of rehospitalizations and revisions was higher after an interventional treatment of the jaundice (14.3% vs. 47.8%). Most revisions involved a changing of the stent within 30 days of the first placement. Limitations of this study include its retrospective analysis, the relatively small number of 58 patients who fit the criteria and were included and the high number of simultaneously performed pancreatic resections during surgery in palliative intention. In conclusion the choice of treatment for hyperbilirubinemia in patients with pancreatic cancer still is a complex one which requires to assess the suspected length of survival, the current performance status of the patient, the involvement of surrounding tissue and the knowledge of the tumor characteristics. If the expected survival time is less than six months, the performance status of the patient is poor or the tumor has infiltrated the ligamentum hepatoduodenale a non surgical approach should be preferred. However if there is a need for explorative laparoscopy or laparotomy in order to assess resectability, after a non successful ERCP or the need for several ERCPs for new stent placement during a short period of time, surgical treatment of the hyperbilirubinemia should be considered if the patient fits the criteria for general anesthesia.de
dc.contributor.coRefereeSchön, Margarete Prof. Dr.
dc.title.alternativeTranslatedwhich is the more effective way to chemotherapy?de
dc.subject.gerPPPDde
dc.subject.gerWhipplede
dc.subject.gerHyperbilirubinämiede
dc.subject.gerIkterusde
dc.subject.gerChemotherapiede
dc.subject.gerGallengangsstentde
dc.subject.gerHepaticojejunostomiede
dc.subject.gerCholestasede
dc.subject.gerObstruktionde
dc.subject.gerpalliativde
dc.subject.geradjuvantde
dc.subject.gerERCPde
dc.subject.gerStentde
dc.subject.gerGemcitabinede
dc.subject.gerFOLFIRINOXde
dc.subject.gerpaclitaxelde
dc.subject.gererlotinibde
dc.subject.gerSorafenibde
dc.subject.gerOxaliplatinde
dc.subject.gerEtoposidde
dc.subject.gerBilirubinde
dc.subject.enghyperbilirubinemiade
dc.subject.engpancreatic cancerde
dc.subject.engjaundicede
dc.subject.engstentde
dc.subject.engwhipplede
dc.subject.engPPPDde
dc.subject.engchemotherapyde
dc.subject.engtraversode
dc.subject.engcholestasisde
dc.subject.engbiliaryde
dc.subject.engobstructionde
dc.subject.enggemcitabinede
dc.subject.engFOLFIRIONOXde
dc.subject.engbilirubinde
dc.subject.engERCPde
dc.subject.engpaclitaxelde
dc.subject.engerlotinibde
dc.subject.engSorafenibde
dc.subject.engOxaliplatinde
dc.subject.engEtoposidde
dc.identifier.urnurn:nbn:de:gbv:7-ediss-14569-0
dc.affiliation.instituteMedizinische Fakultätde
dc.subject.gokfullChirurgie - Allgemein- und Gesamtdarstellungen (PPN619875968)de
dc.description.embargoed2023-03-29de
dc.identifier.ppn1839067543
dc.notes.confirmationsentConfirmation sent 2023-03-14T06:15:01de


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