BACKGROUND: To date, only limited data are available regarding the routine surgical management of patients with exocrine pancreatic cancer (PC) in German community and university hospitals. METHODS: With the use of a standardized questionnaire, a national survey on surgical and oncological treatment concepts for PC in Germany was conducted on behalf of the Chirurgische Arbeitsgemeinschaft Onkologie and Arbeitsgemeinschaft Internistische Onkologie. The surgical part of that questionnaire contained 25 questions on criteria regarding resectability, surgical techniques, perioperative patient management, and palliative surgical procedures in advanced PC. Data were collected centrally and analyzed using the SPSS(®) software. Additionally, predefined subgroup analyses, classifying the results by the professional site of the responding physician and the local annual number of treated patients, were carried out. RESULTS: One-hundred and two questionnaires on the surgical survey section were returned. For the majority of the survey respondents, arterial infiltration is the most important criterion for non-resectability of PC (common hepatic artery, 69.9%; superior mesenteric artery, 85.3%; celiac trunk, 86.3%), whereas only 17.6% would define non-resectability based on portal vein infiltration; 69.9% consider extrapancreatic tumor manifestations as a criterion of surgical non-resectability. Of the survey participants, 53.9% perform a biliary drainage in case of preoperative cholestasis, whereas 43.1% reject this preoperative endoscopic-interventional approach. For cancers of the pancreatic head, 24.5% of surgical units recommend a classical Kausch-Whipple procedure, 52.9% prefer the pylorus-preserving partial pancreatoduodenectomy, and 20.6% use both procedures; 74.5% routinely perform a standard lymphadenectomy, whereas 16.7% prefer an extended procedure. A radical pancreatic resection would be performed by 63.7% of survey respondents also if a single liver metastasis would be found intraoperatively. CONCLUSION: Surgical treatment of PC in Germany is heterogeneous; future efforts to implement an evidence-based and standardized surgical management will be necessary.
BACKGROUND: To date, only limited data are available regarding the routine surgical management of patients with exocrine pancreatic cancer (PC) in German community and university hospitals. METHODS: With the use of a standardized questionnaire, a national survey on surgical and oncological treatment concepts for PC in Germany was conducted on behalf of the Chirurgische Arbeitsgemeinschaft Onkologie and Arbeitsgemeinschaft Internistische Onkologie. The surgical part of that questionnaire contained 25 questions on criteria regarding resectability, surgical techniques, perioperative patient management, and palliative surgical procedures in advanced PC. Data were collected centrally and analyzed using the SPSS(®) software. Additionally, predefined subgroup analyses, classifying the results by the professional site of the responding physician and the local annual number of treated patients, were carried out. RESULTS: One-hundred and two questionnaires on the surgical survey section were returned. For the majority of the survey respondents, arterial infiltration is the most important criterion for non-resectability of PC (common hepatic artery, 69.9%; superior mesenteric artery, 85.3%; celiac trunk, 86.3%), whereas only 17.6% would define non-resectability based on portal vein infiltration; 69.9% consider extrapancreatic tumor manifestations as a criterion of surgical non-resectability. Of the survey participants, 53.9% perform a biliary drainage in case of preoperative cholestasis, whereas 43.1% reject this preoperative endoscopic-interventional approach. For cancers of the pancreatic head, 24.5% of surgical units recommend a classical Kausch-Whipple procedure, 52.9% prefer the pylorus-preserving partial pancreatoduodenectomy, and 20.6% use both procedures; 74.5% routinely perform a standard lymphadenectomy, whereas 16.7% prefer an extended procedure. A radical pancreatic resection would be performed by 63.7% of survey respondents also if a single liver metastasis would be found intraoperatively. CONCLUSION: Surgical treatment of PC in Germany is heterogeneous; future efforts to implement an evidence-based and standardized surgical management will be necessary.
Authors: James J Mezhir; Murray F Brennan; Raymond E Baser; Michael I D'Angelica; Yuman Fong; Ronald P DeMatteo; William R Jarnagin; Peter J Allen Journal: J Gastrointest Surg Date: 2009-09-23 Impact factor: 3.452
Authors: Shailesh V Shrikhande; Jörg Kleeff; Carolin Reiser; Jürgen Weitz; Ulf Hinz; Irene Esposito; Jan Schmidt; Helmut Friess; Markus W Büchler Journal: Ann Surg Oncol Date: 2006-10-25 Impact factor: 5.344
Authors: Aaron R Sasson; John P Hoffman; Eric A Ross; Steven A Kagan; James F Pingpank; Burton L Eisenberg Journal: J Gastrointest Surg Date: 2002 Mar-Apr Impact factor: 3.452
Authors: Christoph W Michalski; Mert Erkan; Norbert Hüser; Michael W Müller; Mark Hartel; Helmut Friess; Jörg Kleeff Journal: Dig Surg Date: 2009-02-12 Impact factor: 2.588
Authors: Christina Haane; Wolf Arif Mardin; Britta Schmitz; Sameer Dhayat; Richard Hummel; Norbert Senninger; Christina Schleicher; Soeren Torge Mees Journal: Langenbecks Arch Surg Date: 2013-10-19 Impact factor: 3.445
Authors: J Jakob; A Gerres; U Ronellenfitsch; L Pilz; M Wartenberg; B Kasper; H-R Raab; P Hohenberger Journal: Chirurg Date: 2018-01 Impact factor: 0.955