The 129th Congress of the German Society of Surgery
Meeting with EH editor Brigitte Dinkloh, Congress Secretary Professor Alexis Ulrich MD (left), Assistant Medical Director at the Clinic for General, Visceral and Transplant Surgery at the University of Heidelberg, outlined the scientific programme, discussed some impressive advances in surgical procedures, and explained why the gathering bears the slogan Surgery in Partnership.
‘The 129th Congress is the annual meeting of the German Society of Surgery, which is comprised of ten specialist societies,’ Professor Alexis Ulrich explained. ‘The congress is also the venue for the annual meeting of the German Society for General and Visceral Surgery. The congress programme is therefore very comprehensive, with more than 1,700 lectures, posters and 19 specialist satellite symposia. ‘Each of the four days of the congress has a key focus: On Tuesday it will be on Research and Studies, on Wednesday Surgery in Partnership, on Thursday Perioperative and Intensive Medicine and, on Friday, Organisation and Management.’
‘The issue is not only the integration of research results into daily clinical life but also state-of-the-art procedures to introduce guideline-compliant and low-risk surgical procedures as well as new operating techniques to the audience. ‘A particular highlight will be the live transmission, directly into the largest congress hall, of surgical interventions on the large abdominal blood vessels, pancreas and rectum. ‘For the first time, the congress will also host ‘grand slam’ discussions on controversial topics where the persuasiveness of the opponents can be rated via audience surveys. The German Surgery Congress is an important scientific congress and also an opportunity for training, which is why there will be updates on different treatment strategies for almost all regions of the body.’
Current state-of-the-art procedures
‘Starting with rectal surgery, we need to mention total mesorectal excision (TME), a procedure established in Germany since the late 1990s. It is now the gold standard treatment for rectal cancer. However, this new surgical procedure put the entire treatment concept to the test again. Currently there is a question, for example, as to whether and at what tumour stage the conventional, multimodal treatment approach, such as radiation before surgery, is still necessary, given the optimised local radicalness of TME. ‘Another branch of research is looking into the individualisation of treatment adapted to the respective tumour stage. The connection between molecular markers and the use of certain antibodies in adjuvant tumour therapy will be another topic.
First study results give reason to be hopeful that this so-called individualised tumour treatment will become even more important in the future. ‘Minimally invasive surgery will be another important topic at the congress. The controversial issue here is whether even further reductions in the already small number of very small access points for surgery combined with new, significantly smaller but more expensive instruments could result in improvements to the quality of life.
‘Results produced by surgical robots to date will also be of great interest. In any case, experience so far has shown that in regions of the body where, once access has been gained, a lot depends on the tactile sense of the surgeon due to poor visibility, minimally invasive surgery does have its drawbacks. Through the use of robots and intelligent assistance systems – in future with 3-D images – it is hoped that better visibility and therefore better results can be achieved. Advances made in this field will be presented at the congress
‘Obesity surgery has become increasingly important over the last few years. It has mainly been carried out – with a low risk of complications – to treat overweight patients. When a gastric bypass – mostly under disconnection of the duodenum - was fitted, a high percentage of insulin-dependent diabetics no longer required insulin immediately after the surgery. This physical mechanism of the clinical cure of diabetics after gastric bypass has not yet been scientifically explained, and many international research groups are currently working on this phenomenon. My colleagues PD D. Beat Müller and Dr Michael Frenken will present a report summarising experiences gained from 140 patients on this topic.
‘This will also feature at the congress. A lot of importance here is being attributed to the diagnostic evaluation and the avoidance of reperfusion injuries. In the latter case the issue is how to prevent the influx of the toxins, which can develop in the cells after long periods of organ cooling, into the bloodstream.
In pancreatic surgery, where the stomach-preserving Whipple procedure is the gold standard these days, there are still typical complications that should be reduced through improved surgical techniques. In the first instance this concerns the supply of the remaining part of the pancreas, which is prone to the development of fistulas. For instance, one question is whether the seam of the remaining part of the pancreas should be created with the stomach or with the small intestine.’
Another topic is the question whether, and for whom, individualised treatment approaches such as radiochemotherapy lead to better results. This also concerns patients with locally advanced tumour stages who were previously excluded from surgery. Helped by local radiation it has been possible, as first study results have shown, to achieve tumour reduction in about 25% of cases, which then facilitates radical surgery and therefore improves life expectancy and quality of life.’
A new oral vaccination
‘Currently still an experimental approach, the oral vaccination of patients with non-resectable pancreatic cancer involves the use of modified bacteria that carry a certain gene to stimulate the body’s immune system into attacking and destroying the blood vessels of the tumour. PD Dr Schmitz-Winnenthal will introduce this study.’
Surgery in Partnership
‘Surgery today is inconceivable without its medical partner disciplines. This includes first, obviously, the nurses, but also colleagues from the fields of anaesthesia, oncology, radiotherapy and nuclear medicine. We all know, or should know, that these days the only way to be successful in the sense of curing patients is to work in an interdisciplinary manner. ‘However, on the other hand many new developments in medicine sometimes lead to a competitive way of thinking. When stents suddenly open an alternative to a heart bypass
or other large vessels, doctors should discuss the pros and cons among themselves to achieve an individualised treatment recommendation. This is the topic that will mainly feature on the Wednesday under the motto Surgery in Partnership.’
German surgery today
‘In the first 20-30 years after the war we had quite a lot of clinical and scientific catching up to do. The US in particular took the lead in medicine, which, before the outbreak of war, was held by Germany for half a century. German surgery has now caught up to such an extent that there is no longer a clinical supremacy position. ‘However, we haven’t quite caught up on the same level in science, compared to the US, Scandinavia and the Netherlands, particularly in the case of clinical studies in the sense of evidencebased surgery. Randomised studies have shown that patients benefit when they are not treated with the procedures being most strongly promoted, but in fact those with the best-proven results.
‘Being aware of this need to catch up, Professor M Büchler, the current president, encouraged the foundation of the Study Centre of the German Society of Surgery in Heidelberg in 2003. In joint cooperation with the German Research Foundation and the Federal Ministry of Education and Research, the Study Centre supports the planning, implementation and evaluation of multi-centric, randomised controlled studies of all German surgeons, based on the criteria of good clinical practice. This will be demonstrated during the Tuesday focus – Research and Studies.