Chirurgie (Heidelberg, Germany)最新文献

{"title":"[Localized soft tissue sarcomas].","authors":"Madelaine Hettler, Jens Jakob","doi":"10.1007/s00104-025-02267-2","DOIUrl":"https://doi.org/10.1007/s00104-025-02267-2","url":null,"abstract":"<p><p>Soft tissue sarcomas are rare malignant tumors originating from mesenchymal tissue. They are mostly located in the extremities, followed by the trunk and retroperitoneal regions. The group of soft tissue sarcomas comprises over 80 distinct histological subtypes, each with unique biological characteristics, with liposarcomas and leiomyosarcomas being the most frequent subtypes. In the clinical practice the algorithm from image, biopsy and (sarcoma) board has become established for the diagnostics of any soft tissue space-occupying lesion exceeding 3 cm in size. This enables the planning of a wide R0 resection, which can be defined as the standard for sarcoma surgery. For locally advanced and/or frequently metastasizing tumors, (neo)adjuvant radiotherapy and/or chemotherapy are usually indicated. Patients benefit from a sarcoma board to determine the treatment strategy. After treatment, clinical and radiological follow-ups should be conducted every 3-6 months, depending on the grade of the primary tumor.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Cure probabilities after resection of ductal adenocarcinoma of the pancreas: a multi-institutional analysis of 2554 patients].","authors":"Laura Schwenk, Michael Ardelt, Utz Settmacher","doi":"10.1007/s00104-025-02280-5","DOIUrl":"https://doi.org/10.1007/s00104-025-02280-5","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Time for change: what must the high-quality surgical training network of tomorrow offer? : Perspectives and demands of the Young Forums of the Surgical Societies in Germany].","authors":"Frederik Schlottmann, Sebastian Schaaf, Romina Maria Rösch, Maria E Dey Hazra, Marit Herbolzheimer, Sabine Drossard, Louisa Schuffert, Benedikt J Braun, Sarah Lif Keller, Arash Motekallemi, Joscha Mulorz, Hruy Menghesha, Anna Lawson McLean, Tobias Huber, Frederic Bouffleur, Gerrit Freund","doi":"10.1007/s00104-025-02269-0","DOIUrl":"https://doi.org/10.1007/s00104-025-02269-0","url":null,"abstract":"<p><strong>Background: </strong>The hospital structural reform through the Hospital Treatment Remuneration Improvement Act (Krankenhausversorgungsverbesserungsgesetz, KHVVG) will fundamentally change the medical care landscape in Germany starting in 2025. Outpatient care and cross-sectoral care models will substantially influence advanced surgical training. In particular, comprehensive training networks between hospitals and outpatient facilities are being discussed as a core solution to ensure surgical training.</p><p><strong>Objective: </strong>The aim of this position paper is to highlight the wishes and demands of young surgeons regarding training alliances. These should serve as guidelines for the stakeholders involved for a successful implementation.</p><p><strong>Material and methods: </strong>The position paper is based on discussions of the Young Forums of surgical societies, analyses of current further training models and experiences from pilot projects. It describes measures that promote cross-sectoral structured further training with clear legal, financial and didactic framework conditions.</p><p><strong>Results: </strong>Successful models, such as rotation in outpatient facilities, show a positive effect on further training and practical experience. Necessary steps include simplifications of labor legislation, transparent curricula, adequate financing and certified didactic qualifications for those providing surgical residency training. Pilot projects underline the potential of intersectoral cooperation, while inadequate legal and financial structures have been identified as the main obstacles.</p><p><strong>Conclusion: </strong>The introduction of mandatory continuous education networks is essential to ensure surgical residency training and improving the quality of surgical patient care. In addition to political action to finance and adapt the framework conditions, hospitals and outpatient facilities need to take the initiative. In the long term surgical continuing education in Germany should be of exceptional quality.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Frozen sections in hepatobiliary surgery].","authors":"Sven A Lang, Lara R Heij, Jan Bednarsch, Ulf P Neumann","doi":"10.1007/s00104-025-02264-5","DOIUrl":"https://doi.org/10.1007/s00104-025-02264-5","url":null,"abstract":"<p><p>Complete removal of the tumor (R0 resection) is one of the most important prognostic factors for overall and recurrence-free survival in patients with hepatobiliary malignancies. Accordingly, the intraoperative confirmation of tumor-free resection margins is of central importance. At the same time, despite extensive preoperative diagnostics intraoperative findings can arise that require immediate histological clarification. For example, the discovery of peritoneal carcinomatosis or previously unknown intrahepatic metastases often leads to the termination of the operation and thus to a change in the oncological concept. In addition, the estimation of the local tumor spread, particularly in the case of biliary tumors related to the liver hilum, is sometimes difficult based on preoperative imaging, so that a timely intraoperative assessment of tissue samples is necessary to confirm the resectability. The possibility of intraoperative frozen section diagnostics is, therefore, of particular importance, especially in complex surgical interventions in the hepatobiliary area.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Perioperative chemotherapy or neoadjuvant chemoradiotherapy in the multimodal treatment of esophageal cancer-Results of the ESOPEC trial].","authors":"L M Schiffmann, C J Bruns","doi":"10.1007/s00104-025-02270-7","DOIUrl":"https://doi.org/10.1007/s00104-025-02270-7","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Relevance of frozen section diagnostics in pancreatic surgery].","authors":"Patricia Wyzlic, Alexander Damanakis, Alexander Quaas, Christiane J Bruns, Thomas Schmidt","doi":"10.1007/s00104-025-02265-4","DOIUrl":"https://doi.org/10.1007/s00104-025-02265-4","url":null,"abstract":"<p><p>Frozen sections are performed in pancreatic surgery for three reasons: histopathological confirmation of previously unclear space-occupying lesions, determination of the extent of surgical resection in an operative exploration and for possible follow-up resections after previously carried out surgical resections. Overall, in the literature there are heterogeneous data with respect to an improvement in the prognosis of a secondary R0 resection by a repeat resection in comparison to a R1 resection. Nowadays, extended pancreatic resections including vascular resections are technically feasible and safe. Nevertheless, with respect to the precise radicality in the surgical procedure, all patient characteristics should be taken into consideration in addition to the histopathological diagnosis of the frozen sections.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Reinforced fascial suture after midline laparotomy-The Rein4CeTo1 trial].","authors":"Schaima Abdelhadi, Christoph Reißfelder","doi":"10.1007/s00104-025-02271-6","DOIUrl":"https://doi.org/10.1007/s00104-025-02271-6","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Surgical anatomy of the anorectum].","authors":"Tillmann Heinze, Marvin Heimke, Sigmar Stelzner, Thilo Wedel","doi":"10.1007/s00104-025-02244-9","DOIUrl":"https://doi.org/10.1007/s00104-025-02244-9","url":null,"abstract":"<p><p>The anorectum corresponds to the last segment of the gastrointestinal tract and is responsible for mediating fecal continence and controlled defecation. An understanding of the complex topographic anatomy is an indispensable prerequisite for the surgical treatment of benign and malignant diseases in the anorectal region. The detailed description of perirectal fascia, anorectal blood supply and lymph vessel drainage, pelvic autonomic nerves and components of the anal canal and anal sphincter complex has significantly contributed to improvement of the oncological and functional surgical outcome. In this article the state of knowledge relating to the anorectal anatomy is outlined providing a practical basis for rectal and proctological surgical procedures.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Challenges in outpatient surgical treatment in Germany].","authors":"Johannes Klose, Claudia Rudroff, Lars Fischer, Artur Rebelo, Jörg Kleeff, Ralf Michael Wilke","doi":"10.1007/s00104-025-02263-6","DOIUrl":"https://doi.org/10.1007/s00104-025-02263-6","url":null,"abstract":"<p><strong>Background: </strong>In Germany the proportion of outpatient and day clinic surgery within the surgical service provision is still increasing. Recently, the catalogue of operations which can be carried out in outpatient surgery was revised and an intersectoral remuneration was introduced; however, the prerequisites in the surgical departments for an increased provision of outpatient services are very heterogeneous.</p><p><strong>Objective: </strong>The aim of this study was to analyze the current situation and challenges of outpatient care in general and visceral surgery in Germany.</p><p><strong>Material and methods: </strong>A questionnaire with 26 questions on the current situation of the treatment structure for outpatient surgery was constructed and the possibility for surgical training under outpatient conditions was surveyed. The questionnaire was digitally sent via the mailing list of the German Society for General and Visceral Surgery and the Convention of Senior Hospital Surgeons (Konvent der leitenden Krankenhauschirurginnen und -chirurgen) and the completed questionnaires were analyzed.</p><p><strong>Results: </strong>A total of 204 head physicians took part in the survey. In 54.4% the surgeons were in charge of basic care hospitals followed by specialized and maximum care hospitals. An outpatient structure was present in 95.5% of the hospitals with a high proportion of medical care centers. The majority of the surgeons planned to extend outpatient services despite the lack of comprehensive structures. Even if a structured education curriculum for junior doctors does not exist up to 70% of outpatient operations are performed by junior doctors. The current status of outpatient surgery care in Germany was evaluate as weak by 70% of the participants. An improvement due to the implementation of a new intersectoral remuneration is not expected.</p><p><strong>Discussion: </strong>Within the hospital landscape the structures for outpatient surgery show clear differences.</p><p><strong>Conclusion: </strong>Of the participants two thirds felt that despite the existing infrastructure their hospital was not well-prepared for the increased provision of outpatient services and assessed the associated remuneration as insufficient.</p>","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A cold nodule, a dramatic course and a curious finding].","authors":"Julia Goller, U Müller, F Butz, C Kunze, A Abazid, J Pratschke, N Huschitt, M Mogl","doi":"10.1007/s00104-025-02262-7","DOIUrl":"https://doi.org/10.1007/s00104-025-02262-7","url":null,"abstract":"","PeriodicalId":72588,"journal":{"name":"Chirurgie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}