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Pankreaschirurgie

Der Chirurg als entscheidender Prognosefaktor

Surgery of the pancreas

The surgeon as the crucial prognostic factor

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  • 6 Citations

Zusammenfassung

Die operative Therapie bei Patienten mit Pankreastumoren bietet die einzige Chance auf Heilung. Auch bei Patienten mit akuter oder chronischer Pankreatitis ist ein operatives Vorgehen zur Behandlung von Komplikationen oft indiziert. Neben zahlreichen weiteren Einflussfaktoren ist es mittlerweile allgemein anerkannt, dass der Pankreaschirurg bezüglich der lokalen Befundbeurteilung (z. B. beim Karzinom richtige Einschätzung der Resektabilität), der operativen Ergebnisse, dem postoperativen Komplikationsmanagement, der Lebensqualität und Prognose dieser Patienten eine zentrale Schlüsselposition als unabhängiger Prognosefaktor einnimmt. Durch mehrere Studien konnte beispielsweise gezeigt werden, dass in Zentren mit niedrigen Fallzahlen (≤3 resezierende Pankreaseingriffe pro Jahr) die Mortalität bei über 15% liegt, während in Zentren mit sehr hohen Fallzahlen (≥16) diese weniger als 5% beträgt. Darüber hinaus konnte gezeigt werden, dass in diesen so genannten „High-volume-Krankenhäusern“ die Kosten pro Patient im Vergleich zu „Low-volume-Krankenhäusern“ geringer sind. Aufgrund seiner persönlichen Erfahrung und aufgrund seines technischen Könnens hat der Pankreaschirurg deshalb in einem spezialisierten multidisziplinären Team eine entscheidende und wesentliche Beratungs- und Führungsfunktion.

Abstract

Pancreatic surgery offers the sole chance for cure in patients with pancreatic tumors, and is often inevitable in cases of acute and chronic pancreatitis. Among the long list of prognostic factors, the central place of the surgeon is now recognized as a key, independent prognostic factor for the outcome and quality of life of these patients. The volume-outcome effect in pancreatic surgery will lead to new policies aiming to improve patient safety and health care quality by the creation of pancreas units, i.e. centers of excellence where patients can be treated by multidisciplinary teams which have developed a high expertise in the management of diseases of the pancreas. Numerous studies have shown that postoperative mortality after major pancreatic surgery is reduced in centers performing ≥16 resections per year with a mortality rate of <5% compared with hospitals doing ≤3 resections per year with a mortality rate >15%. A further effect is that the cost per patient is reduced in high volume hospitals compared to those with a low volume. The pancreatic surgeon plays a key role not only due to personal experience and technical skills, but also as a leader in a specialized multidisciplinary team.

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Correspondence to Prof. Dr. W. Uhl.

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Belyaev, O., Herzog, T., Chromik, A. et al. Pankreaschirurgie. Gastroenterologe 1, 34–42 (2006). https://doi.org/10.1007/s11377-006-0007-z

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Schlüsselwörter

  • Pankreaschirurgie
  • Prognosefaktor
  • Pankreaszentrum
  • Chirurgische Erfahrung
  • Interdisziplinäre Versorgung

Keywords

  • Pancreatic surgery
  • Prognostic factors
  • Pancreas units
  • Surgeon experience
  • Multidisciplinary approach