[Current and Future Role of Vascular Surgery Expertise for Visceral Surgeons - an Expert Survey]. / Aktueller und künftiger Stellenwert der gefäßchirurgischen Expertise für Viszeralchirurgen ­ eine Expertenbefragung.

BACKGROUND: Due to improved surgical techniques and safer perioperative management, there has been an increase in radical abdominal and oncological operations. Simultaneous vascular interventions are increasingly necessary - either after preoperative planning or after an intraoperative vascular emergency. It is unclear whether German visceral surgeons have the required vascular surgical skills. An assessment of the current and future status of vascular techniques within visceral surgery is therefore the issue of the present survey. METHODS: A questionnaire was sent to the chairs of visceral surgery of German university hospitals and to the directors of non-academic surgical departments in 2017. Thus, we sought to assess the current and future status of vascular surgery within abdominal and oncological operations. There were person-, hospital-, system-, and intervention-related questions to be answered. RESULTS: Compared to non-academic hospitals, significantly more vascular interventions were performed within abdominal surgery at university hospitals (p < 0.001), where generally more such expertise is available. Surgical support from vascular surgeons is present in a majority of both academic and non-academic institutions (72.8%). However, almost one third of respondents expressed a desire for more vascular surgery expertise at their departments. An optional rotation in vascular surgery exists predominantly at university hospitals (92.9 vs. 73.8%; p = 0.031). A slim majority of all surgical managers assumes that vascular surgery will play an increasing role in the future of visceral and oncological surgery (51.6%) and favours obligatory rotation for visceral surgery residents of at least six months (54.1%). Necessary skills to be taught include thrombectomy and embolectomy (95.6%), vascular suture (98.6%) and patch (89.1%) as well as vascular bypass surgery (45.5%). CONCLUSIONS: There is an expert consensus that vascular surgery is of increasing significance for visceral surgeons. In spite of the possibility of optional rotations for residents at most hospitals, there seems to be a demand for more expertise in vascular surgery at several departments. Obligatory rotation in vascular surgery should be discussed within training programs for visceral surgery.

[Vascular Complications and Emergencies within Oncologic Abdominal Surgery - What Knowledge and Skills Are Essential for the Visceral Surgeon]. / Vaskuläre Komplikationen und Notfälle in der onkologischen Viszeralchirurgie ­ was muss ein Viszeralchirurg können und wissen.

Background Continuous improvements in perioperative and neoadjuvant therapy concepts nowadays permit more extensive tumor resections with curative intention. In patients with arterial or venous tumour involvement in preoperative imaging, physicians with expertise in vascular surgery should be involved in the planning phase of the operation. Unexpected vascular complications during abdominal surgery demand prompt management by the oncological surgeon. However, skills in vascular surgery are still not obligatory for the visceral surgeon in training. This topic is controversial and is therefore the focus of the present study. Patients and Methods From 2010 - 2015, a total of 126 patients underwent visceral operations involving vascular surgical interventions. Of these, 30 operations were performed as radical tumour resections. Retrospective data acquisition was performed with a minimum follow-up of 12 months. Aside from comprehensive characterisation of patients and their diseases, an outcome analysis was conducted. Furthermore, visceral surgery training programs in accordance with all 17 German federal medical associations were analysed and compared with respect to vascular surgery teaching. Results Vascular surgery was necessary in most patients, due to lesions of the mesentericoportal venous system (n = 11; 37%) and visceral arteries (n = 14; 47%). Techniques involved were mostly vascular sutures, reanastomosis or patch plastic surgery (n = 19; 63%) and venous thrombectomy/arterial embolectomy (n = 18; 60%). Hospital mortality was 3%. During follow-up, 33% of oncological patients died, whereas solely venous injury was an independent adverse prognostic variable (arterial vs. venous complications: HR 0.028; 95%-CI 0.002 - 0.442; p = 0.01). Skills in vascular surgery are optional for up to 12 months within visceral surgery training. Conclusions Intraoperative vascular complications in visceral surgical oncology are rare but pose severe risks for the patients. Their management requires basic knowledge and skills in vascular anatomy, preparation and skills to ensure immediate safe control of bleeding, as well as suture techniques and interposition grafts. Current training and specialisation in visceral surgery does not include obligatory vascular surgery teaching, so that this issue needs reevaluation.