1. Information about this Guideline – Pancreatic Cancer
1.1 Editors
The German Guideline Program in Oncology (GGPO) organized by the Association of the Scientific Medical Societies in Germany (AWMF), the German Cancer Society (DKG) and the German Cancer Aid Foundation (DKH).
1.2 Leading Scientific Societies
Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS)
1.3 Funding of the Guideline
This guideline was supported by the German Cancer Aid Foundation (DKH) within the framework of the German Guideline Program in Oncology.
1.4 Contact
Office Leitlinienprogramm Onkologie
c/o Deutsche Krebsgesellschaft e. V.
Kuno-Fischer-Straße 8
D-14057 Berlin
leitlinienprogramm@krebsgesellschaft.de
www.leitlinienprogramm-onkologie.de
1.5 How to cite
Leitlinienprogramm-Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Pancreatic Cancer, Langversion 3.0, 2024, AWMF-Registernummer 032/010OL, https://www.leitlinienprogramm-onkologie.de/leitlinien/pankreaskarzinom/
1.6 Special Comment
Medicine is subject to a continuous development process, so that all information, especially in regard to diagnostic and therapeutic procedures, can only correspond to the state of knowledge at the time when the guideline is printed. The greatest possible care has been taken with regard to the recommendations given for therapy and the selection and dosage of medications. Nevertheless, users are urged to consult the manufacturers' package inserts and expert information for verification and, in case of doubt, to consult a specialist. In the general interest, any discrepancies should be reported to the OL editorial office.
The user is responsible for any diagnostic and therapeutic application, medication and dosage.
In this guideline, registered trademarks (protected trade names) are not specially marked. Therefore, the absence of a corresponding reference does not necessarily mean that it is a free trade name.
The work is protected by copyright in all its parts. Any use outside the provisions of copyright law without the written consent of the OL editorial office is prohibited and punishable by law. No part of the work may be reproduced in any form without the written permission of the OL editorial office. This applies in particular to reproductions, translations, microfilming and the storage, use and exploitation in electronic systems, intranets and the Internet.
1.7 Objectives of the GGPO
By establishing the German Guideline Program in Oncology (GGPO), the Association of Scientific Medical Societies (AWMF), the German Cancer Society (DKG) and the German Cancer Aid Foundation have set out to jointly promote and support the development, updating and use of scientifically based and practicable guidelines in oncology. The program is based on the medical-scientific findings of AWMF and the DKG, the consensus of medical experts, users and patients, as well as the set of rules for the development of guidelines put forth by the AWMF, and the professional support and funding by the German Cancer Aid Foundation. In order to reflect the current state of medical knowledge and advances in medicine, guidelines must be reviewed and updated on a regular basis. The implementation of AWMF regulations is intended to provide the basis for the development of high-quality oncological guidelines. Since guidelines are an important instrument of quality assurance and quality management in oncology, they should be introduced into everyday care in a targeted and sustainable manner. Thus, active implementation measures as well as evaluation programs are an important part of promoting the German Guideline Program in Oncology. The aim of the program is to create a professional and financially secure basis for the development and provision of high-quality guidelines in Germany. These high-quality guidelines not only facilitate the structured transfer of knowledge, but can also play a role in shaping structures of the healthcare system. Evidence-based guidelines provide the foundation for the creation and updating of disease management programs. Quality indicators derived from guidelines can be used in the framework of the certification of organ tumor centers.
1.8 Additional Documents relating to this Guideline
This document is the 3rd update of the S3 Guideline on Exocrine Pancreatic Cancer (Version 3.0). This Guideline is available on the following websites:
- DGVS (www.dgvs.de)
- German Guideline Program in Oncology (https://www.leitlinienprogramm-onkologie.de/leitlinien/pankreaskarzinom/)
- AWMF (https://register.awmf.org/de/leitlinien/detail/032-010OL)
- Guidelines International Network (www.g-i-n.net)
In addition to the long version, there are the following supplementary documents to this Guideline:
- Short version of the Guideline
- Patient Guideline (lay version)
- Guideline Report
All of these documents are also available on the websites listed above.
This Guideline is also included in the app of the German Guideline Program in Oncology.
For more information, see: https://www.leitlinienprogramm-onkologie.de/app/
1.9 Composition of the Guideline Group
1.9.1 Coordination and Reaction
Prof. Dr. med. Thomas Seufferlein, Universitätsklinikum Ulm [Ulm University Hospital]
Prof. Dr. med. Julia Mayerle, Universitätsklinikum München [Munich University Hospital]
Leitliniensekretariat [Guidelines Administration Office]
Pia Lorenz, M.Sc., DGVS Berlin
Nadine Fischer, M.Sc., DGVS Berlin
1.9.2 Involved Professional Societies and Organisations
The following table lists all the participants in the guideline's second update (2021). The authors involved in the first version (2006) and the first update (2013) are listed in the previous versions (see Guideline archive, https://www.leitlinienprogramm-onkologie.de/leitlinien/pankreaskarzinom/).
Table 1: Beteiligte Fachgesellschaften und Organisationen
| Beteiligte Fachgesellschaften und Organisationen | Mandatsträger |
|---|---|
| Arbeitsgemeinschaft Bildgebende Onkologie | Prof. Dr. Stefan Böck Prof. Dr. Lars Grenacher |
| Arbeitsgemeinschaft Bildgebung in der Onkologie der DKG (ABO) | Prof. Dr. Andreas Schreyer Prof. Dr. Lars Grenacher |
| Arbeitsgemeinschaft Deutscher Tumorzentren (ADT) | Prof. Dr. Stefan Rolf Benz |
| Arbeitsgemeinschaft für Psychoonkologie in der DKG (PSO) | Dipl.-Psych. Beate Hornemann |
| Arbeitsgemeinschaft Internistische Onkologie in der DKG (AIO) | Prof. Dr. Stefan Böck |
| Arbeitsgemeinschaft onkologische Pathologie in der DKG (AOP) | Prof. Dr. Andrea Tannapfel Prof. Dr. Irene Esposito |
| Arbeitsgemeinschaft Palliativmedizin in der DKG (APM) | Dr. Parvis Sadjadian |
| Arbeitsgemeinschaft Prävention und integrative Medizin in der Onkologie in der DKG (PRiO) | Dipl. Oec. Troph. Christine Reudelsterz |
| Arbeitsgemeinschaft Radiologische Onkologie in der DKG (ARO) | Prof. Dr. Frank Zimmermann |
| Arbeitsgemeinschaft Supportive Maßnahmen in der Onkologie in der DKG (AGSMO) | Prof. Dr. Alexander Stein |
| Arbeitskreis der Pankreatektomierten (AdP) | Horst Neuendorf Bernd Rühling |
| Berufsverband Deutscher Pathologinnen und Pathologen (BDP) | Prof. Dr. Andrea Tannapfel Prof. Dr. Irene Esposito |
| Chirurgische Arbeitsgemeinschaft für Leber-, Galle- und Pankreas (CALGP) der DGAV | Prof. Dr. Tobias Keck Prof. Dr. Jens Werner |
| Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) | Prof. Dr. Waldemar Uhl Prof. Dr. Jens Werner Prof. Dr. Thilo Hackert Prof. Dr. Tobias Keck |
| Deutsche Gesellschaft für Chirurgie (DGCH) | Prof. Dr. Christiane Bruns Prof. Dr. Tobias Keck Prof. Dr. Jens Werner |
| Deutsche Gesellschaft für Endoskopie und bildgebende Verfahren (DGE-BV) | Prof. Dr. Karel Caca |
| Deutsche Gesellschaft für Ernährungsmedizin (DGEM) | Prof. Dr. Johann Ockenga |
| Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) | Prof. Dr. Volker Ellenrieder Prof. Dr. Thomas Gress Prof. Dr. Patrick Michl Prof. Dr. Thomas Seufferlein Dr. Thomas Ettrich Dr. Angelika Kestler Prof. Dr. Jonas Rosendahl Prof. Dr. Roland Schmid |
| Deutsche Gesellschaft für Humangenetik (GfH) | Prof. Dr. Reiner Siebert |
| Deutsche Gesellschaft für Hämatologie und Medizinische Onkologie (DGHO) | Prof. Dr. Volker Heinemann Prof. Dr. Volker Kunzmann PD Dr. Helmut Oettle PD Dr. Marianne Sinn |
| Deutsche Gesellschaft für Innere Medizin (DGIM) | Prof. Dr. Julia Mayerle |
| Deutsche Gesellschaft für Nuklearmedizin (DGN) | Prof. Dr. Ken Herrmann |
| Deutsche Gesellschaft für Palliativmedizin (DGP) | PD Dr. Ulrich Wedding |
| Deutsche Gesellschaft für Pathologie (DGP) | Prof. Dr. Irene Esposito Prof. Dr. Andrea Tannapfel |
| Deutsche Gesellschaft für Radioonkologie (DEGRO) | Prof. Dr. Thomas Brunner PD Dr. Sabine Semrau |
| Deutsche Gesellschaft für Ultraschall in der Medizin (DEGUM) | Prof. Dr. Christoph Frank Dietrich |
| Deutsche Röntgengesellschaft (DRG) | Prof. Dr. Andreas Schreyer |
| Eingeladene Fachexperten (ohne Stimmrecht) | Prof. Dr. Robert Grützmann Prof. Dr. Anke Reinacher-Schick |
| Schweizer Gesellschaft für Gastroenterologie (SGG) | PD Dr. Christoph Gubler |
| Österreichische Gesellschaft für Gastroenterologie und Hepatologie (ÖGGH) | Dr. Angela Djanani |
The Guideline Group consists of representatives of all specialist groups involved in the histopathological diagnosis and therapy of pancreatic carcinoma in the outpatient and inpatient sector, including the self-help groups. The respective specialist societies or associations were contacted already for the previous update (2020/2021) and asked to send representatives of their groups to the guideline group. For the current update, continued participation was queried briefly once again and confirmed in writing.
The Guideline chapters were drafted in the working groups. Additional information on the members of the working groups can be found in the Guideline report.
1.9.3 Arbeitsgruppen
Table 2: Arbeitsgruppen
|
Arbeitsgruppe |
Mitglieder der Arbeitsgruppe (AG-Leiter fett markiert) |
|
Risk Factors, Risk Groups and Screening |
Thomas Gress, Stefan Rolf Benz, Karel Caca, Angelika Kestler, Reiner Siebert, Jens Werner, Jonas Rosendahl |
|
Diagnostics |
Lars Grenacher, Julia Mayerle, Irene Esposito, Ken Herrmann, Tobias Keck, Roland Schmid, Christoph Frank Dietrich |
|
Surgical Therapy |
Wolfgang Uhl, Andrea Tannapfel, Andreas Schreyer, Patrick Michl, Thomas Ettrich, Christiane Bruns |
|
Neoadjuvant/Adjuvant Therapy |
Thomas Brunner, Thilo Hackert, Marianne Sinn, Robert Grützmann, Helmut Oettle |
|
Palliative Therapy |
Volker Heinemann, Volker Kunzmann, Anke Reinacher-Schick, Sabine Semrau, Frank Zimmermann |
|
Palliative Tumor-directed Therapy and Supportive Therapy |
Stefan Böck, Ulrich Wedding, Volker Ellenrieder, Beate Hornemann, Johann Ockenga, Christine Reudelsterz, Jörn Rüssel, Parvis Sadjadian, Alexander Stein |
|
WG Across Chapters |
Horst Neuendorf, Bernd Rühling, Thomas Seufferlein |
|
WG Quality indicators |
Thomas Brunner, Lars Grenacher, Angelika Kestler, Julia Mayerle, Thomas Seufferlein, Waldemar Uhl, Susanne Blödt, Markus Follmann, Michael Gerken, Johannes Rückher, Simone Wesselmann |
1.9.4 Other Patient Involvement (without voting rights)
Steering group
The members of the steering group were appointed by the professional societies and working groups involved in the Guidelines in agreement with the Guidelines coordinators. They each held responsibility for one topic of the update. The steering group defined the key questions (see chapter 2.1.1. Objectives and questions) for the Guidelines update and prioritized the processing of the questions in terms of time. The members of the steering group also acted as leaders of the respective working groups.
|
Steering group (in alphabetical order, coordinators marked in bold) |
|
Brunner T., Ettrich T., Follmann M., Gress T., Grenacher L., Hackert T., Heinemann V., Karge T., Kestler A., Köster M.-J., Langer T., Lynen Jansen P., Mayerle J., Nothacker M., Rütters D., Seufferlein T., Sinn S., Tannapfel A., Uhl W. |
1.9.5 Patient Involvement
Representatives of the self-help organization Arbeitskreis der Pankreatektomierten (AdP) were directly involved in the 3rd update of the Guideline.
1.9.6 Methodological Support
- through the German Guideline Program in Oncology:
- Dr med. Monika Nothacker (AWMF), Berlin
- Dr. rer. medic. Susanne Blödt (AWMF), Berlin
- Dr. Markus Follmann, MPH, MSC (DKG), Berlin
- Dipl.-Soz.Wiss. Thomas Langer (DKG), Berlin
- through the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS):
- PD Dr. Petra Lynen Jansen, Berlin
- Pia Lorenz, M.Sc., Berlin
- Nadine Fischer, M.Sc., Berlin
- through external contractors:
- Department for Knowledge Management of the German Cancer Society (DKG):
- Steffi Derenz, Berlin
- Marie-Jolin Köster, Berlin
- Dana Rütters, Berlin
1.10 Abkürzungsverzeichnis
Table 3: Abkürzungen
| Abkürzungen | Erläuterungen |
|---|---|
| ABO | Working Group on Imaging in Oncology (DKG) |
| ACS-NSQIP | American College of Surgeons National Surgical Quality Improvement Program |
| AdP | Arbeitskreis der Pankreatektomierten - German Patient Self-help Organization |
| ADT | Working Group of German Tumor Centers |
| AGSMO | Working Group Supportive Measures in Oncology |
| AHC | Arteria hepatica communis - Common Hepatic Artery |
| AIO | Working Group Internal Oncology of the DKG |
| ALP | Alkaline phosphatase |
| AMS | Arteria mesenterica superior - Superior mesenteric artery |
| AOP | Working Group Oncological Pathology (DKG) |
| APM | Working Group Palliative Medicine (DKG) |
| ARO | Working Group Radiological Oncology |
| ASCO | American Society of Clinical Oncology |
| ASCO-PCO | American Society of Clinical Oncology provisional clinical opinion |
| ATM | Ataxia-teleangiectasia mutated |
| AWMF | Association of the Scientific Medical Societies |
| ÄZQ | German Agency for Quality in Medicine (Ärztliches Zentrum für Qualität in der Medizin) |
| BDP | Federal Association of German Pathologists |
| BID | Twice a day |
| BMI | Body-Mass-Index |
| BR | Borderline resectable |
| BRCA 1 | Breast Cancer Associated Gene 1 |
| BRCA 2 | Breast Cancer Associated Gene 2 |
| BRCA1/2 | Breast Cancer Associated Gene 1/2 |
| BRPC | Borderline resectable pancreatic cancer |
| CA | Contrast agent |
| CA19-9 | Carbohydrate antigen 19-9 |
| CALGP | Surgical Working Group for Liver, Gallbladder and Pancreatic Diseases |
| CAO-V | Surgical Working Group Oncology |
| CAPS | International Cancer of the Pancreas Screening Consortium |
| CDKN2A | Cyclin Dependent Kinase Inhibitor 2A |
| CDR | Clinical decision rule |
| CEA | Carcinoembryonic antigen |
| CGS | Clinical Guideline Services |
| CI | Confidence interval |
| CONKO | Charité Onkologie |
| CR | Complete response |
| CRM | Circumferential resection margin |
| CT | Computed tomography |
| DEGAM | German College of General Practitioners and Family Physicians (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin) |
| DEGRO | German Society for Radiation Oncology |
| DEGUM | German Society for Ultrasound in Medicine |
| DFS | Disease-free survival |
| DGAV | German Society for General and Visceral Surgery |
| DGCH | German Society for Surgery |
| DGE | German Nutrition Society |
| DGE BV | German Society for Endoscopy and Imaging Procedures e.V. |
| DGEM | German Society for Nutritional Medicine |
| DGHO | German Society for Hematology and Oncology |
| DGIM | German Society for Internal Medicine |
| DGKL | German Association for Clinical Chemistry and Laboratory Medicine |
| DGN | German Society for Nuclear Medicine |
| DGP | German Society for Palliative Medicine |
| DGP | German Society for Pathology |
| DGVS | German Society for Gastroenterology, Digestive and Metabolic Diseases |
| DHC | Ductus Hepatocholedochus |
| DKG | German Cancer Society |
| dMMR | Mismatch repair deficiency |
| DRG | German Radiological Society |
| EC | Expert consensus |
| ECOG | Eastern Cooperative Oncology Group |
| EGF | Epidermal growth factor |
| EORTC | European Organisation for Research and Treatment of Cancer |
| EPCAM | Epithelial cell adhesion molecule |
| ERCP | Endoscopic retrograde cholangiopancreatography |
| ESPAC | European Study Group for Pancreatic Cancer |
| EUS | Endoscopic ultrasound |
| FAMMM | Familial Atypical Multiple Mole Myeloma |
| FANCC/ FANCG | Fanconi anemia group C protein |
| FAP | Familial Adenomatous Polyposis Coli |
| FDA | Food and Drug Administration (US agency) |
| FDG-PET | Fluorodeoxyglucose positron emission tomography |
| FFCD/SFRO | Fédération Francophone de Cancérologie Digestive / Sociéte Française de Radiothérapie Oncologique |
| FPC | Familial pancreatic cancer |
| FU | Fluorouracil |
| G-CSF | Granulocyte colony-stimulating factor |
| GCP | Good Clinical Practice |
| GEKID | Society of Epidemiological Cancer Registries in Germany |
| GEM | Gemcitabine |
| GERCOR | Groupe Cooperateur Multidisciplinaire en Oncologie |
| GfH | German Society for Human Genetics |
| GGPO | German Guideline Program in Oncology |
| GM-CSF | Granulocyte Macrophage Colony-Stimulating Factor |
| HDR | Homology Directed Repair |
| HNPCC | Hereditary Non-polyposis Colorectal Carcinoma Syndrome |
| HR | Hazard ratio |
| IAP | International Association of Pancreatology |
| IMEBI | Institute for Medical Epidemiology, Biometry and Informatics |
| IORT | Intraoperative radiotherapy |
| IPMN | Intraductal papillary mucinous neoplasm |
| ITT | Intention to treat |
| JPS | Japan Pancreas Society |
| KOK | Conference of Oncological Nurses and Pediatric Nurses, DKG working group |
| LA | Locally advanced |
| LAPC | Locally advanced pancreatic cancer |
| LFS | Li-Fraumeni syndrome |
| LN | Lymph nodes |
| LNR | Lymph node ratio |
| LoE | Level of Evidence |
| MCN | Mucinous cystic neoplasm |
| MLH1 | MutL homolog 1 gene |
| MMRd | Mismatch repair deficiency |
| MPACT | Metastatic Pancreatic Adenocarcinoma Clinical Trial |
| MRCP | Magnetic resonance cholangiopancreaticography |
| MRI (eng) | Magnetic resonance imaging |
| MSI-H | Microsatellite instability high |
| NCCN | National Comprehensive Cancer Network |
| NGS | Next generation sequencing |
| NOD | New onset diabetes (NID) |
| NSAR | Non-steroidal anti-inflammatory drug(s) |
| NYHA | New York Heart Association |
| ÖGGH | Austrian Society for Gastroenterology and Hepatology |
| OP | Surgery |
| ORR | Objective Response Rate |
| OS | Overall survival |
| PALB2 | Partner and localizer of BRCA2 gene |
| PanIN | Pancreatic Intraepithelial Neoplasia |
| PDAC | Pancreatic Ductal Adenocarcinoma |
| PET | Positron emission tomography |
| PFS | Progression-free survival |
| PICO | Population Intervention Comparison Outcome |
| PJS | Peutz-Jeghers syndrome |
| PMS | Mismatch repair endonuclease |
| PR | Partial response |
| PrIO | Working Group Prevention and Integrative Oncology |
| PS | Performance Status |
| PSO | Working Group Psycho-oncology of the German Cancer Society |
| PTCD | Percutaneous transhepatic cholangiodrainage |
| PV | Portal vein |
| QLQ | Quality of Life Questionnaire |
| R | Resectable |
| R0 | Resection in healthy tissue |
| RCT | Radiochemotherapy |
| RECIST | Response Evaluation Criteria in Solid Tumors |
| RTOG | Radiation Therapy Oncology Group |
| SBRT | Stereotactic body radiation therapy |
| SGG | Swiss Society of Gastroenterology |
| SIRT | Selective internal radiotherapy |
| SPC | Sporadic pancreatic cancer |
| SR | Systematic review |
| STK11 | Peutz-Jeghers syndrome |
| TC | Coeliac trunk |
| TMB | Tumor mutational burden |
| TNM | Tumor-Nodes-Metastases |
| TNM | System of classification for the anatomical spread of malign tumours with the primary tumour (T), regionalry lymph nodes (N), and distant metastases (M) |
| UICC | Union international contre le cancer |
| US | Ultrasound |
| USA | United States of America |
| USPSTF | US Preventive Services Task Force, US working group for preventive measures |
| VCI | Inferior vena cava |
| VMS | Superior mesenteric vein |
| WBC | White blood count |
| WHO | World Health Organization |
| WOPN | Walled-off pancreatic necrosis |