Vaskuläre Komplikationen und Notfälle in der onkologischen Viszeralchirurgie – was muss ein Viszeralchirurg können und wissen

Abstract

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. 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. 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. 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.