title: Surgical treatment concepts for patients with pancreatic cancer in Germany--results from a national survey conducted among members of the "Chirurgische Arbeitsgemeinschaft Onkologie" (CAO) and the "Arbeitsgemeinschaft Internistische Onkologie" (AIO) of the Germany Cancer Society (DKG).
abstract: 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.
  
  
  CONCLUSIONS
  Surgical treatment of PC in Germany is heterogeneous; future efforts to implement an evidence-based and standardized surgical management will be necessary.
authors: Department of Internal Medicine III, Klinikum Grosshadern, Ludwig Maximilian University of Munich, Munich, Germany.
authors: Mirja
authors: M
authors: Sargent
authors: Stefan
authors: S
authors: Boeck
authors: Volker
authors: V
authors: Heinemann
authors: Karl-Walter
authors: KW
authors: Jauch
authors: Thomas
authors: T
authors: Seufferlein
authors: Christiane J
authors: CJ
authors: Bruns
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D003657:Decision Making; D005858:Germany; D019538:Health Care Surveys; D006801:Humans; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011795:Surveys and Questionnaires