Dear Patients,

in the Clinic for General, Visceral, Vascular and Transplant Surgery at Magdeburg University Hospital, the treatment of the entire spectrum of diseases of the liver, gallbladder and bile ducts is carried out. In addition to surgical procedures, this also includes the implementation of interdisciplinary multimodal therapies.

An expertise exists in minimally invasive (keyhole) laparoscopic and robotic-assisted liver surgery. In the field of robot-assisted liver surgery, the clinic is one of the leading centers in Europe. In addition, all conventional (open) procedures including in situ split liver resections and liver transplants are performed.

In our special consultation hours, we advise you on treatment options for:: 

• benign and malignant diseases of the liver
• metastases in the liver
• benign and malignant diseases of the gallbladder
• benign and malignant diseases of the bile ducts
• Obtaining second opinions

Consultation and therapy planning take place in the surgical special consultation hour. In addition, all tumor diseases are discussed in the interdisciplinary tumor board (Hepatology. Radiology, Oncology, Radiation Therapy, Pathology, Palliative Medicine) with corresponding findings and patient-oriented therapy recommendations. The interdisciplinary approach ensures treatment at a high uninversity level according to the latest scientific standards.

In addition to surgical treatment, the entire spectrum of local and systemic therapies is offered in cooperation with other departments (radiology, gastroenterology/hepatology, nutritional medicine, psycho-oncology).

Outpatient Specialty Consultation:: 

Friday: 8:00 Uhr - 10:00 Uhr 

Appointment by phone at any time under tel.: 0391/67-15529 bzw. 0391/67-21472

Prof. Dr. med. Aristotelis Perrakis

Dr. med. Jörg Arend

Dr. med. Mareike Franz

Dr. med. Mirhasan Rahimli

In order to be able to make a timely recommendation, we need the following documents, if available::

1. a referral slip for the current quarter

2. the valid health insurance card

3. previous findings (outpatient or inpatient records)

4. image findings (CT, MRI), images burned on CD

5. existing examination results (pathology, laboratory)

Advance transmission of the findings by mail is possible at the following address:: 

Oncology expertise 

Magdeburg University Hospital is particularly specialized in the treatment of cancer and offers many years of experience in the necessary surgical procedures. If you have a malignant disease, an interdisciplinary tumor conference is held before and after surgery to discuss whether further targeted treatment (e.g. chemotherapy, radiation) will be necessary. If chemotherapy is necessary, we work closely with the gastroenterological oncology department or with your treating oncologist. In this way, you can be cared for by one team throughout the entire treatment period and always have a contact person for your questions.

ndividual multimodal therapies

In order to offer you an individually adapted therapy concept, we work closely with colleagues from gastroenterology, radiology, radiotherapy, nuclear medicine, anesthesiology and pathology. This close collaboration enables us to draw on the entire spectrum of modern therapeutic modalities for each patient, which, in addition to surgical procedures, also includes endoscopic (ERCP, PTCD, photodynamic therapy) and radiological-interventional procedures (transarterial chemoembolization, radiofrequency ablation, brachytherapy, selective internal radiotherapy, SIRT). In this way, especially patients with advanced tumor diseases can be treated in the sense of a multimodal therapy concept.

As our patient, you will therefore be treated by specialized physicians from several disciplines before, during and after your inpatient stay. Our guiding principle is that the doctor comes to the patient and not the patient has to go to the doctor. Already in the consultation hour you will be seen by specialized doctors of different disciplines, who will prepare an individualized treatment plan for you, and explain in detail the planned therapy or operation.

Appointments are then organized by our patient management team. If an inpatient stay becomes necessary, you will be cared for on our Ward 1, which specializes in liver and biliary tract diseases.

Operation planning and preparation

Surgical treatment of diseases of the liver includes a wide range of surgical techniques. Especially for the liver operations frequently performed in our clinic, which require the removal of more than half of the liver tissue, precise surgical planning is necessary to avoid postoperative complications.

The preparation for the operation is carried out in combination on an outpatient basis via the patient management (Tel.: 0391/67-21401) and on an inpatient basis. In order to ensure optimal conditions for the operation, appropriate preoperative diagnostics are required

. 

This includes (if not already present):

1. Imaging (computed tomography (CT) thorax+abdomen, magnetic resonance imaging (MRI) liver).
2. Endoscopy of stomach and intestines
3. Liver function test (LiMAx®)
4. Laboratory diagnostics
5. Tumor markers (AFP, CEA, Ca 19-9)

Furthermore, the patient is informed about the operation and the required presentation to the anesthesiologist. 

Inpatient stay

Die stationäre Aufnahme erfolgt einen Tag präoperativ auf der Station Chirurgie 1 (Tel.: 0391/67-15522), Haus 60a, Ebene 5. 

Die Operation dauert je nach Befund mehrere Stunden. Nach der Operation erfolgt die Beratung bei größeren Leberresektionen auf der Intensivstation (Tel.: 0391/67-15521). 

Am ersten postoperativen Tag kann mit dem langsamen Kostaufbau begonnen werden. Weiterhin beginnt auf der Intensivstation die Mobilisation durch die Physiotherapie. 

Bei guter Leberfunktion und stabilen Vitalparametern erfolgt 1.-2. postoperativer Tag der Rückverlegung auf die chirurgische Station 1. 

Hier wird die postoperativ begonnene Mobilisation und der Kostaufbau fortgeführt. Zusätzlich erfolgt eine Mitbetreuung durch den Sozialdienst zur Planung einer Rehabilitation. 

Patienten mit Tumorerkrankungen erhalten eine Ernährungsberatung, bei Wunsch eine seelsorgerische Begleitung und eine psychoonkologische Beratung. 

Die Entlassung ist je nach Befund und operativem Verfahren zwischen dem 5. und dem 12. Tag postoperativ. 

Minimal-invasive Chirurgie

Die minimal-invasive Chirurgie ("Schlüssellochchirurgie") stellt ein Standardverfahren bei der Entfernung der Gallenblase dar. Auch in der Leberchirurgie erfolgt die Mehrheit der Operationen minimal-invasiv. Hier kommt neben dem laparoskopischen Verfahren die Roboter-assistierte Leberresektion zum Einsatz. Durch die Roboter-assistierte Chirurgie sind auch hoch komplexe Eingriffe an der Leber möglich. 

Die allgemeinen Vorteile der minimal-invasiven Chirurgie (kleine Narben, weniger postoperative Schmerzen, geringe Beeinträchtigung des Immunsystems, schnellere Erholung der Magen- und Darmmotalität, kürzerer Krankenhausaufenthalt) gelten jedoch natürlich auch für die Chirurgie von Leber und Bauchspeichedrüse. Faher werden in unserer Klinik zunehmend auch komplexere Leber- und Bauchspeicheldrüsenoperationen minimal invasiv durchgeführt. Atypische und anatomische Leberteilresektion, sowie Pankreaslinksresektion bei gutartigen Erkrankungen werden routinemäßig laparoskopisch durchgeführt. Hierzu können wir auf modernste 3D Videosysteme zurückgreifen. 

Benign liver diseases, 

usually only require surgery for size increase or discomfort. Usually, these conditions can be treated with minimally invasive methods. 

1. Liver adenoma

Liver adenomas are the third most common benign liver disease. They often occur on their own and have a risk of complications (hemorrhage, rupture, malignant transformation) with increasing size. Depending on size and symptoms, therapy consists of cessation of hormone use, follow-up, resection, or local ablation. 

2. Liver cysts

Liver cysts are the most common benign liver finding. The incidence is 170/100000 inhabitants. Women are more frequently affected and cysts in other organs (kidney, pancreas) are not uncommon. Cysts without symptoms and without wall changes are only followed up. Symptomatic large cysts can be treated very well by minimally invasive surgery.

If more than 10 liver cysts are present, this is called polycystic liver disease. This is often combined with polycystic kidney disease. Due to the associated enlargement of the liver, symptoms often occur. Treatment depends on the symptoms and ranges from minimally invasive or local radiological therapy to liver transplantation. 

3. Hemangiomas

Liver hemangioma is one of the most common benign liver findings. The diagnosis is predominantly made in the course of a diagnostic examination; women are more frequently affected than men. In 80% of cases the hemangioma is solitary. The therapy is conservative in the vast majority. Sympotomatic hemangiomas or unclear findings can be resected surgically.

4. Focal Nodular Hyperplasia (FNH) 

Focal nodular hyperplasia is the second most common benign liver tumor. The diagnosis is usually made as an incidental finding. Women are affected significantly more often and 80% occur solitarily. In asymptomatic findings, follow-up is performed. Hormone therapies should be discontinued if the size increases. Surgery is indicated in symptomatic and unclear findings. 

5. Infectious liver cysts (echinococci)

Echinococcosis is widespread worldwide. Diagnosis is made by imaging (CT, MRI, ultrasound) as well as serologically in the blood. Asymptomatic, uncomplicated cysts are treated with medication. Complicated, symptomatic cysts are resected after drug pretreatment. After surgery, drug therapy is continued.

Malignant diseases of the liver

1. Hepatocellular carcinoma (HCC) 

Hepatocellular carcinoma is the most common primary liver tumor with increasing incidence. In 88%, liver cirrhosis is present in addition to HCC. Therapy is based on tumor findings and degree of cirrhosis. HCC in compensated cirrhosis (Child-Pugh score A, early B) can be operated minimally invasively. In advanced cirrhosis, local ablative procedures (radiofrequency ablation, brachytherapy, transarterial chemoembolization, selective internal radiotherapy, microwave ablation) or drug therapy are available. Depending on the findings, a combination of surgical and interventional procedures may also be used.  

In all patients with hepatocellular carcinoma in liver cirrhosis, the indication for liver transplantation is reviewed due to the high recurrence rate (about 75% in 5 years). Transplantation allows simultaneous treatment of the tumor and liver cirrhosis. Through this, a long-term recurrence-free survival can be achieved. The decision on the possibility of transplantation is made after detailed medical evaluation and discussion in the transplantation conference and in the interdisciplinary tumor board.

2. Cholangiocellular carcinoma (CCC)

Intrahepatic cholangiocarcinoma is the second most common primary liver tumor. The incidence is 0.5-1/10000 population. There are many risk factors such as biliary cysts, chronic biliary tract inflammation, autoimmune diseases and parasites. Cirrhosis of the liver is also present in 16%.

Surgery with liver resection and removal of the regional lymph nodes is the treatment of choice. The extent of liver resection depends on the tumor findings and liver function and ranges from segmental resections to extended hemihepatectomies (resection 70-80% of the liver).

3. Metastases in the liver

The most common malignant disease of the liver is the metastasis of a colon cancer to the liver. Surgical removal of liver metastases is the best treatment option and can be performed several times if necessary. Within the framework of our interdisciplinary tumor conference, we recommend whether liver metastases should be removed before the colon cancer is removed (so-called "live first approach") or after surgery for the colon cancer. At the same time, the type and timing of chemotherapy and, in individual cases, ablative therapy are suggested. 

Benign and malignant diseases of the gallbladder

1. Stone ailments

One of the most common operations in Germany, with 170,000, is surgery on the gallbladder. In most cases, the operation is performed for complaints due to gallstones. The diagnosis is made by the laboratory chemistry tests and ultrasound. Approximately 5-25% of the population have gallstones. Women are more often affected than men and the risk of gallstones increases after the age of 40. 

There is an indication for surgery in case of discomfort. Other indications are gallbladder stones over 3cm in size, porcelain gallbladder and polyps of the gallbladder over 1cm in size.

The vast majority of procedures are performed laparoscopically (keyhole surgery). Only rarely a conventional (open) surgery is required. 

2. Inflammations 

Inflammation of the gallbladder (acute/chronic) occurs predominantly due to gallstones. These lead to obstruction of the gallbladder duct. 5-10% of acute cholecystitis occurs without stone aftermath. The acute inflammation often leads to pain in the right upper abdomen, nausea and vomiting. Acute cholecystitis is an indication for laparoscopic cholecystectomy. 

3. Gallbladder tumors 

Gallbladder tumors are rare and more often affect women and occur at an older age. After removal of the gallbladder, the diagnosis is often made as an incidental finding. Risk factors are gallbladder polyps over 0.5cm, gallbladder stones over 3cm, porcelain gallbladder and infections. Symptoms occur with advanced disease and may be nonspecific. These include loss of appetite, weight loss, nausea/vomiting, pain, jaundice and itching. Diagnosis is made by ultrasound and CT/MRI. 

Surgery is the treatment of choice. Liver resection with gallbladder removal and lymph node removal is performed. In advanced cases, extended liver resection or bile duct resection may be required. In addition, multimodality therapy with chemotherapy, radiotherapy, and surgery is possible. The decision on the treatment concept is made in the interdisciplinary tumor board.

4. Gallbladder polyps

Critical Analyse of the Updated Guidelines for Management of Gallbladder Polyps. Hassan A et. al; Annals of Surgical Oncology; 29; 3363-3365 (2022)

Benign and malignant diseases of the bile ducts

The therapy of Klatskin tumors in particular requires seamless interdisciplinary cooperation. As part of the pretreatment, stents are inserted by endoscopic procedures to relieve the pressure on liver segments to be preserved. Since surgery for Klatskin tumors is usually only possible by extensive liver resection, portal vein embolization can be performed preoperatively by radiologists, which leads to an increase in volume (hypertrophy) of the remaining liver. This ensures adequate liver function after surgery. 

For large liver tumors, we also use modern procedures such as the so-called "Associating Liver Partition and Portal vein Ligation for Staged hepatectomy" (ALPPS) to induce volume hypertrophy.

In order to ensure international data collection and thus scientific evaluation, as well as quality control, our clinic is a member of international scientific networks, which  Behandlung von Gallengangskarzinomen und die Anwendung des ALPPS-Verfahrens betreffen. 

Further Information:

• Deutsches Krebsstudien Register - Aktuell in Deutschland durch geführte Studien  (deutschsprachig): http://www.studien.de
• EORTC European Organisation for Research and Treatment of Cancer - Internationale Studien  (englischsprachig): http://www.eortc.org
• Deutsche Gesellschaft für Chirurgie  (deutschsprachig): http://www.dgch.de
• Deutscher Pankreasclub e.V.  (deutschsprachig): http://www.pankreasclub.de/
• Deutsche Krebsgesellschaft e.V. (deutschsprachig): http://www.krebsgesellschaft.de/
• Arbeitskreis der Pankreatektomierten e.V.  (deutschsprachig): http://www.adp-dormagen.de/
• Deutsche Akademie für Mikrotherapie: www.dafmt.de