At the Zentralklinik Bad Berka, under the direction of Professor Dr. med. Merten Hommann, patients can expect outstanding care in the fields of general surgery and visceral surgery. Prof. Dr. Merten Hommann is particularly well-known for his pioneering work in the treatment of neuroendocrine tumors and pancreatic surgery. The clinic is distinguished not only by its medical expertise but also by the warm and compassionate care provided to every patient.
The Zentralklinik Bad Berka offers a wide range of visceral surgical procedures at the highest level. From the treatment of malignant tumors of the gastrointestinal tract to diseases of the pancreas and the endocrine system—here, patients receive comprehensive care from a multidisciplinary team of specialists. An outstanding example of this interdisciplinary collaboration is the “Center for Neuroendocrine Tumors,” which is certified as a Center of Excellence by the “European Neuroendocrine Tumor Society.”
Under the leadership of Prof. Dr. Hommann, the surgical team has specialized in the individualized care of patients with neuroendocrine tumors. Thanks to their dedicated commitment and many years of experience, they have built up expertise that benefits patients from all over the world. The clinic relies on innovative methods such as the high-energy gamma probe for the precise localization of tumors during surgery and the use of state-of-the-art technologies such as irreversible electroporation (IRE) in pancreatic surgery.
Prof. Dr. Hommann and his team place great importance on treating each patient as an individual and offering personalized treatment. In doing so, they take into account not only the latest scientific findings and technologies but also the patients’ personal needs and wishes. The commitment of Prof. Dr. Hommann and his team to research and continuing education ensures that the clinic remains at the cutting edge of medicine.
The editorial team of the Leading Medicine Guide had the opportunity to learn more about visceral surgery—specifically regarding the pancreas and liver—in a conversation with the expert Prof. Dr. Hommann.
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Visceral surgery encompasses a broad spectrum of surgical procedures in the abdominal cavity that focus on the diagnosis and treatment of diseases of the internal organs. These include, among others, pancreatic surgery—which addresses conditions and tumors of the pancreas—as well as liver surgery, which deals with diseases and tumors of the liver. These areas of surgery require specialized expertise and innovative treatment methods to ensure optimal patient care.
Diseases of the pancreas and liver can cause serious health problems that require careful medical evaluation and often surgical intervention.
“There is a wide variety of diseases affecting the pancreas and the liver, but of course not all of them require surgical treatment, as there are both benign and malignant conditions. Conservative therapies are also an option. Even if a malignant condition has been diagnosed, the Tumor Board conducts an interdisciplinary discussion to determine whether the patient can be spared surgery. After all, it’s important to remember that for patients, there is no such thing as a ‘minor’ operation—every procedure is, in the truest sense of the word, an incision. And especially when it comes to the liver and pancreas, these are generally complex surgeries, with the most common indications being tumors, precancerous lesions, or metastases. Even in cases of benign conditions, surgery is sometimes unavoidable for the patient; for example, in cases of chronic pancreatitis, which can cause not only pain but also a blockage in the bile duct or make it difficult to eat. Surgery is also performed on the liver, for example, in the case of a large but benign liver adenoma, as it can become malignant or rupture. “Liver cysts are usually removed using minimally invasive surgery, as they can cause pressure or displace other structures,” explains Prof. Dr. Hommann at the beginning of our conversation, and goes on to list examples where surgery is not necessary:
“However, if a patient has, for example, a benign serous cystic tumor in the pancreas that causes no symptoms, surgery would not be considered. The same applies to benign liver lesions, known as focal nodular hyperplasia (FNH), lobed connective tissue with a scar in the center, or in the case of a hemangioma—a benign liver tumor consisting of a cluster of abnormal blood vessels. Typically, these conditions are simply monitored at regular intervals—which, in the case of the pancreas, is done using an endoscopic ultrasound, and in the case of the liver, using an MRI with a liver-specific contrast agent.”
In a healthy adult, the liver weighs approximately 1.5 kilograms. If a cyst inside it grows to the size of a grapefruit, the patient will notice it. This is because, in certain positions, the cyst can cause symptoms of pressure. It can also compress blood vessels, disrupting blood flow and increasing the risk of thrombosis, or it can press on the biliary tract. If this causes noticeable symptoms, surgery should be performed. However, many people live with small cysts without even knowing they have them and grow old with them.
The pancreas, a gland located in the upper abdomen, plays a crucial role in digestion and the regulation of blood sugar levels through the production of enzymes and hormones such as insulin. The liver, the body’s largest internal organ, has a wide range of functions, including the processing of nutrients, the detoxification of harmful substances, and the production of bile for digestion. In cases of pancreatic disease, inflammatory conditions such as acute and chronic pancreatitis, as well as pancreatic pseudocysts, are common problems. These conditions can cause severe abdominal pain, digestive problems, and other symptoms. In addition, pancreatic cancer or pancreatic tumors are a serious condition that is sometimes diagnosed late and has a poor prognosis. Liver diseases may also require various surgical procedures. Liver resections, in which part of the liver is removed, are performed for malignant liver tumors such as hepatocellular carcinoma or metastases from other types of cancer. Liver transplantation is a life-saving option for patients with end-stage liver disease, such as cirrhosis or primary sclerosing cholangitis (PSC), in whom the organ no longer functions properly. Ablative procedures such as radiofrequency ablation (RFA) or microwave ablation (MWA) can be used for small liver tumors to destroy them without performing a resection. The decision to proceed with surgical intervention for pancreatic or liver diseases requires a comprehensive evaluation by an interdisciplinary team of physicians, including surgeons, oncologists, radiologists, and gastroenterologists. The choice of the appropriate procedure depends on the type of disease, the stage, the location of the tumor, and the patient’s overall health.
“If surgical treatment is necessary, many procedures can be performed using minimally invasive techniques. Sometimes, however, open surgery is necessary, depending on the size and location of a cyst or tumor. The trend, however, is definitely toward minimally invasive surgery, as it offers many advantages in terms of pain reduction, recovery, and healing. These procedures are often performed with robotic assistance. For example, robotic assistance makes minimally invasive suturing much easier, and overall, handling the medical instruments is more intuitive and effective. But not everything can be done minimally invasively, and this must be discussed with the patient. There’s certainly nothing wrong with opting for open surgery, as this is sometimes the better approach. For example, with certain tumors—such as neuroendocrine tumors—the surgeon needs to be able to palpate the organ, which is more difficult with minimally invasive procedures and robotic-assisted surgeries. However, technology will certainly continue to advance in the future, making palpation possible even during robot-assisted surgeries. Of course, as an experienced surgeon, you have a sense of how something would feel to the touch, even if you aren’t actually touching it. “It is essential to keep the risk-benefit ratio in mind, and the cost factor—especially with regard to robotics—certainly plays a role,” explains Prof. Dr. Hommann, adding further details regarding the duration of the surgery:
“If we take the removal of a tumor in the pancreas as an example, and the tumor is located in the tail of the pancreas in the left half of the abdominal cavity, then the surgery takes less than 3 hours. However, if the tumor is located in the head of the pancreas in the right half of the abdominal cavity, the procedure typically takes between 5 and 6 hours. The shorter duration of surgery for tumors in the tail is due to the fact that no reconstruction is required on the left side. Surgery on the head of the pancreas involves a significant reconstructive component, because the pancreas must be reattached to the intestine or the stomach, and the bile duct must be reconnected to the small intestine—which, of course, takes more time. The situation is similar in liver surgery. Here, it depends on the location and size of the tumor—does a segment, an outer segment of the liver, or even half the liver need to be removed? The latter takes about 3–4 hours, while removing a segment takes about 2 hours. Everything generally takes longer once structures need to be removed and subsequently replaced or reconstructed.”
Surgical procedures in the field of visceral surgery, particularly pancreatic and liver surgery, are complex procedures that can be associated with a number of risks and complications.
One of the most common complications is bleeding during or after surgery. Since many of these procedures involve manipulation of blood vessels, there is always a risk of uncontrolled bleeding, which requires careful surgical technique to prevent or treat it. “Another complication is fistula formation; that is, in the case of liver surgery, a bile duct is not initially sealed and drains into the free abdominal cavity. With the pancreas, the tricky part is a pancreatic fistula—a leak at the anastomosis between the pancreas and the small intestine or stomach—which can lead to inflammation, sepsis, and secondary bleeding. This is because the aggressive pancreatic juice can erode blood vessels. Today, interventional radiologists can also occlude the vessels from the inside in cases of bleeding—a procedure that is called upon in such rare instances. In this regard, I adhere to the following principle: “A hospital should only perform this surgery if it is also capable of effectively managing complications in this area,” emphasizes Prof. Dr. Hommann.
“In liver surgery, liver failure is the most serious complication. This can occur if the remaining portion of the liver is too small to function fully. However, this is very rare today, as the potential remaining liver volume and the associated liver function can be measured much more accurately before surgery. In addition, surgical techniques have improved thanks to supportive imaging, and advances in surgical equipment allow us to perform procedures with less blood loss and greater anatomical precision. Furthermore, there have been significant improvements in anesthesia and intensive care medicine,” explains Prof. Dr. Hommann.
Pancreatic cancer, also known as pancreatic carcinoma, is one of the most dangerous forms of cancer due to its often late detection and aggressive nature.
The exact causes of pancreatic cancer are not fully understood, but certain risk factors—such as smoking, a family history of pancreatic cancer, chronic pancreatitis, obesity, and an unhealthy diet—can increase the risk. “One of the challenges with pancreatic cancer is that it often causes no early symptoms, which means it is usually diagnosed only in advanced stages. If the tumor is located near the bile duct and blocks it early on, the patient will feel it and develop jaundice without pain—which is a warning sign—and there would be a good chance of diagnosing the pancreatic cancer. The key diagnostic criterion is a positive tissue sample. The crux of the matter is that the tumor is sometimes not captured in the sample; in other words, a positive tissue sample is conclusive, while a negative one is not. Fortunately, patients today go to the doctor more quickly when they notice something, and on top of that, diagnostic imaging has improved, and we doctors also have a better understanding of the precancerous conditions from which such a tumor can develop. “We can guide patients toward appropriate follow-up examinations to prevent this tumor from developing in the first place,” says Prof. Dr. Hommann, highlighting the improved situation compared to the past.
When symptoms do occur, they can be nonspecific and include weight loss, abdominal pain, jaundice, digestive problems, nausea, and vomiting—sometimes back pain, the onset of diabetes, or a venous thrombosis. Pancreatic cancer is often diagnosed through a combination of imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS), as well as laboratory tests and tissue biopsies. Some patients may also undergo diagnostic laparoscopy to obtain further information about the tumor and its spread.
“We are also in a better position today in terms of surgical techniques and have more options. However, it must also be said that if pancreatic cancer is not treated surgically, the prognosis is poor. Pancreatic cancer is very aggressive. For patients, this means that even if the tumor (and any metastases) has been removed macroscopically and microscopically, very few patients survive for five years, unlike with less aggressive tumors. This is because there may be small cancerous deposits that are not located within the surgical field and cannot be reached. And for patients who cannot undergo primary surgery and who have no metastases, there is the option of local ablation using electrical current (irreversible electroporation) following prior systemic therapy, which can then lead to prolonged survival. Which treatment is appropriate for which patient must be decided on a case-by-case basis. As a rule, we try to make surgery possible for the patient through prior therapy,” said Prof. Dr. Hommann regarding the unique characteristics of pancreatic cancer and the challenges associated with it.
Irreversible electroporation (IRE) is a minimally invasive method for treating pancreatic cancer that uses electric fields to destroy cancer cells while sparing healthy tissue. During the procedure, special electrodes are inserted into the tumor, which deliver short, high-voltage electrical pulses. These pulses create pores in the cell membranes of the cancer cells, causing the cells to die. A major advantage of IRE is its precision, as it does not use heat and therefore does not damage sensitive structures such as blood vessels and nerves. The treatment is performed under imaging guidance, such as ultrasound or CT. The entire procedure can take several hours, but the actual application of the pulses lasts only a few minutes. After IRE, patients typically remain in the hospital for a few days for monitoring. Possible side effects include pain, swelling, or mild bleeding. IRE can be used alone or in combination with other therapies, such as surgery or chemotherapy, and offers a promising option for patients with locally advanced pancreatic cancer.
Postoperative care and rehabilitation following pancreatic or liver surgery play a crucial role in supporting recovery and preventing complications.
“In the case of a standard partial pancreatectomy, the patient has a recovery period of approximately 7–14 days, initially in the intensive care unit and then on the general ward, depending on the extent of the procedure. Afterward, the patient typically undergoes rehabilitation, which lasts about 3 weeks. During this time, the topics of nutrition and exercise are discussed again. If, for example, the entire pancreas is removed, it is 100% certain that the patient will subsequently become insulin-dependent. In addition, the patient may need to take medication after a pancreatic resection, such as digestive enzymes. A normal life is generally possible. “Patients we’ve operated on here travel the world and play sports,” says Prof. Dr. Hommann, who also has some words of advice regarding prevention:
“Unfortunately, in Germany, preventive medicine does not yet hold the same importance as it does in other countries. We tend to be a country of ‘repair medicine.’ Yet so much can be done preventively. For instance, one should eat a sensible diet and not commit ‘suicide’ with a knife and fork. Personally, I’m a big advocate of regular fasting. In my opinion, you should consume very little meat (and when you do, it should be organic and, if possible, no pork). You really need to think carefully about your diet and make sure you don’t develop any nutritional deficiencies—and take supplements if necessary. And you should eliminate things that make you sick and stressors (perhaps through meditation) as much as possible and get more exercise.”
In good hands at the Bad Berka Clinic!
The Bad Berka Clinic offers diagnostic and therapeutic options at the highest medical standard, placing great emphasis on compassionate, patient-centered care. It collaborates closely with specialists from other clinics, private practitioners, and partner hospitals to ensure comprehensive patient care.
“Here in Bad Berka, we value patient-centered care. Patients should always receive a listening ear, advice, and empathy. The patient and the doctor must work together and also address any fears. Patients should feel confident asking questions. For the future, I hope to see greater openness toward all medical professions. And surgeons, in particular, should learn that the medical world consists of more than just scalpels and chemotherapy. We need to broaden our medical perspective. After all, there are other wise approaches used by therapists who haven’t necessarily studied medicine, but which can be applied effectively for the patient’s benefit. “I hope for a synthesis of all the good things the medical world has to offer and a shared vision in the best interests of the patient,” says Prof. Dr. Hommann hopefully, and we conclude our conversation with these beautiful thoughts.
Thank you very much, Prof. Dr. Hommann, for this extremely engaging and highly informative conversation!
