科研之友
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摘要
Are Specialized Centres for Hepato-Pancreato-Biliary Diseases Useful? Considerable advances in hepato-pancreato-biliary (HPB) surgery have evolved during the last 30 years. Whereas HPB surgery was performed initially mainly in specialized centres, nowadays a broad range of hospitals offers HPB surgery. However, there are several indications from epidemiological analyses that the postoperative results especially in pancreatic surgery but also in complex liver resections largely depend on the hospital volume. Based on the available data, a minimum case load for complex pancreatic resections has been implemented in Germany. In contrast, no minimum case load is required for liver surgery, among others due to the fact that the operative complexity of liver surgery is broader, starting from relatively simple to highly complex liver resections. At present, two certificates for liver and pancreas centres exist: the emphasis of the certificates of the German Society for General and Visceral Surgery (DGAV) is placed on the surgical treatment of liver and pancreas diseases, whereas the certificates of the German Cancer Society (DKG) are mainly multidisciplinary oncological. From our point of view, centralisation of the treatment of relatively rare diseases requiring very complex surgical operations with a high risk of complications - such as in HPB surgery - is medically and economically useful and sooner or later unavoidable. However, the optimum size and structure of the respective centres remains to be determined.
- 出版日期2011
