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Laparoscopic pancreatoduodenectomy is currently limited to a few tertiary centers worldwide. The slow distribution of this technique since its first description by Gagner and Pomp (Gagner 1994) more than twenty years ago is due to numerous reasons: (1) In contrast to laparoscopic distal pancreatectomy, the laparoscopic pancreatic head resection is characterized by a complex reconstruction involving the pancreatic anastomosis as well as the biliojejunal anastomosis. (2) The technical prerequisites for dissectors and instrumentation have only been developed during the past few years. (3) The combination of laparoscopic proficiency with profound expertise in pancreatic surgery has only just emerged in this new generation of surgeons. In summary, there has been a very dynamic development of the laparoscopic pancreatic head resection during the past few years. There have been published series with over 50 patients demonstrating the feasibility and safety of this technique in specialized centers. In highly specialized teams this technique is even advanced towards more complex surgeries including portal vein resection as well as laparoscopic portal vein reconstruction [1]. The rapid development of this field can be noted when highlighting the number of cases published between January 2012 and June 2013, which exceed the numbers of the 15 years prior [2].

Die differenzierte chirurgische Therapie des Rektumkarzinoms hat in den letzten Jahren dazu gefuhrt, dass bei 80 % der Patienten eine kurative Resektion moglich wurde. Gleichzeitig lassen sich kontinenzerhaltende Operationsverfahren in 85 % der Falle auch laparoskopisch verwirklichen, ohne onkologische Radikalitatsprinzipien preiszugeben. Die Aufgabe des Chirugen dabei ist, Radikalitat und Funktionserhalt zu vereinbaren. Dass der Chirurg beim Rektumkarzinom selbst ein Prognosefaktor ist, zeigten die Daten der multizentrischen „Studiengruppe Kolorektales Karzinom.“ Dies wird umso wichtiger, wenn laparoskopisch onkologisch operiert werden soll. Fur die laparoskopische Rektumchirurgie mussen spezielle Erfahrungen in der offenen Chirurgie des Rektums mit denen der laparoskopischen Chirurgie kombiniert werden. Insbesondere da die laparoskopische Rektumresektion die Vorgaben des offen-konventionellen Verfahrens unbedingt und kompromisslos erfullen muss.

The purpose of this study is to evaluate long-term mortality and quality of life (QoL) of intensive care patients with pneumonia and/or sepsis 1 year after discharge and to identify potential predictors for these outcome measures.This retrospective cohort study analyzed all patients admitted to the intensive care unit (ICU) of a German university hospital with diagnosis of pneumonia and/or sepsis between 2008 and 2009. Quality of life was assessed by telephone interview or mail using the standardized EuroQol 5-dimension questionaire.Of 1406 patients treated in the ICU within the observational period, 217 met the inclusion criteria. Whereas in-hospital mortality differed significantly between pneumonia (17%) and sepsis (46%) (P.001), 1-year mortality was not statistically significant (51% and 65%, P = .057). A high Simplified Acute Physiology Score (SAPS) II value was associated with high in-hospital mortality but failed to predict 1-year mortality. Quality of life, measured 1 year after discharge by visual analog scale (VAS), was 50% ± 25%, which was significantly lower than in a matched control group (70% ± 20%; P.001). A high SAPS II score on admission did not correlate with VAS but was an independent predictor of a low EuroQol 5-dimension index.The high post-ICU mortality of patients with pneumonia and sepsis emphasizes the need to focus on long-term follow-up in ICU studies and demonstrates that even when sepsis signs are missing, critically ill patients due to pneumonia have high 1-year mortality. Simplified Acute Physiology Score II does not predict long-term mortality, but a low SAPS II on admission might be useful to identify patients with good physical status after 1 year.Hospital mortality of patients treated for pneumonia and/or sepsis is high and increases significantly within the first year after discharge. The SAPS II predicts in-hospital mortality and the physical components of QoL but not long-term mortality.One-year mortality of ICU pneumonia patients is equally high as in sepsis patients. Simplified Acute Physiology Score II cannot predict long-term mortality but can predict QoL.

Eine familienfreundliche und gendergerechte Chirurgie – wie soll das gehen? Das Projekt FamSurg bietet Antworten, damit Vereinbarkeit von Familie und Beruf in diesem Fachgebiet kein Widerspruch bleiben muss.