The esophagus and the pancreas are among the central organs of the digestive system—and both play a crucial role in health and quality of life. Diseases of the esophagus and pancreas are often complex, ranging from functional disorders such as heartburn to highly specialized tumor diseases.
Modern visceral surgery today combines minimally invasive and robotic techniques to treat these sensitive organs with precision, care, and oncological safety.
Early symptoms of diseases of the esophagus or pancreas are often so subtle and nonspecific that they can easily be overlooked in everyday life or attributed to harmless causes. This very ambiguity often leads to patients seeking medical attention late—resulting in diagnoses frequently being made at more advanced stages.
„In diseases of the esophagus, it often becomes apparent early on that eating no longer functions as usual. Many affected individuals can hardly swallow solid foods such as meat and unconsciously switch to softer or liquid foods because they pass more easily. This change is one of the most typical early warning signs of an esophageal tumor. With the pancreas, it is different: it lies deep within the body, and by the time a tumor causes symptoms, the disease is often already more advanced.
One of the first symptoms may be a yellowing of the eyes, because the common duct of bile and pancreas becomes narrowed by tumor growth. Patients themselves often do not notice this—usually others point out the yellow eyes. In contrast to inflammatory processes, which can also cause bile congestion, this yellowing in tumors typically occurs without pain. Regardless of the tumor type, many patients develop so-called B symptoms over time: unintentional weight loss, loss of appetite, night sweats, or sleep disturbances.
These symptoms are not specific to a particular organ but are typical of malignant diseases in general. Another warning signal specifically for pancreatic diseases can be newly diagnosed diabetes. Since the pancreas regulates blood sugar metabolism, a tumor may lead to the sudden onset of diabetes—a symptom that should always be investigated, even though it fortunately does not always indicate cancer“, explains Prof. Dr. Bockhorn regarding the initial symptoms, and adds about the causes:
„The most important influencing factors for the development of esophageal and pancreatic cancer are still external stressors such as alcohol, smoking, unhealthy diet, and obesity. In addition, there are recurrent inflammatory processes—for example due to chronic reflux in the esophagus or pancreatitis in the pancreas. Genetic factors also play a role, but research is still in its early stages in reliably determining individual risk profiles.
Prevention is therefore becoming increasingly important: regular check-ups with a primary care physician as well as screening examinations such as gastroscopy and colonoscopy, which have been recommended for years but are still underutilized“.
Diseases of the esophagus and pancreas are evaluated using a multi-step diagnostic approach that combines clinical examination, imaging procedures, functional diagnostics, and laboratory analyzes.
„Many patients already come to the hospital with an initial suspicion or even a confirmed diagnosis because they have noticed the previously mentioned changes—difficulty eating, unexplained fatigue, weight loss, painless yellowing of the eyes, or newly diagnosed diabetes. Primary care physicians play a central role, as they are often the first to recognize these warning signs and refer patients to outpatient gastroenterologists who initiate the initial diagnostics. In suspected esophageal cancer, a gastroscopy with tissue sampling is usually performed.
For the pancreas, diagnostics are more complex because the organ lies deep within the body; here, endoscopic ultrasound is usually required—an ultrasound performed from inside the body—which also allows for targeted biopsy. Once the diagnosis is confirmed, so-called staging follows. This includes endoscopy and imaging procedures such as CT scans of the chest and abdomen to determine the TNM stage: tumor size, lymph node involvement, and the presence of metastases. With this information, the case is presented at an interdisciplinary tumor board—a panel of experts from radiology, gastroenterology, oncology, nuclear medicine, pathology, and surgery.
Together, they decide which therapy is most appropriate for the individual. Depending on tumor type and stage, this may involve surgery, oncological pre-treatment, combination therapy, or in certain cases primary endoscopic treatment. The goal is always to find the best possible, individually tailored therapy—based on the experience of multiple disciplines working together on the case“, explains Prof. Dr. Bockhorn.
Diagnosis is never based on a single finding, but on the combination of symptoms, imaging, functional diagnostics, and laboratory values. It is precisely this integration that makes it possible to distinguish between functional disorders, inflammatory changes, and structural diseases—and to initiate the appropriate therapy at an early stage.
Minimally invasive and robotic procedures have fundamentally transformed surgery of the esophagus and pancreas in recent years, as they enable interventions that were previously associated with significantly greater strain, longer hospital stays, and higher complication rates. Especially in these two organs—located deep within the body, surrounded by sensitive structures, and functionally highly complex—the advantages of precise, tissue-sparing techniques are particularly evident.
Prof. Dr. Bockhorn outlines the greatest challenges for the treating physician: „In surgery of the esophagus and pancreas, each operation has its own Achilles’ heel. In the esophagus, the greatest challenge lies in the new connection between the remaining stomach and the esophagus created after removal of the tumor-bearing section. In the pancreas, it is the highly complex reconstruction of the connection between the gland and the small intestine.
Most complications occur at these points—and how well they are managed depends heavily on the experience of the entire center. What matters is not only the expertise of the surgeon, but also the routine of all involved specialties: anesthesia, gastroenterology, radiology, oncology, and pathology must all be familiar with the specific characteristics of these tumor diseases. This is why centralization and certification are emphasized—because only a well-coordinated, interdisciplinary team can ensure the safety and quality required for such procedures“.
Tumor diseases of the esophagus and pancreas are considered particularly challenging because they often become noticeable late, are located in anatomically complex regions, and affect highly sensitive functional structures. Both organs can compensate for a long time, so early symptoms remain nonspecific and diagnosis is often made only at a stage when the tumor is already locally advanced or has spread to surrounding structures. At the same time, these tumors are biologically aggressive, grow infiltratively, and tend to metastasize early to lymph nodes or distant sites. This makes treatment planning a delicate balance between oncological radicality and functional safety.
Minimally invasive and robotic procedures enable extremely precise, tissue-sparing surgery of the esophagus and pancreas: thanks to magnified visualization, fine instrument control, and stable reconstructions, risks such as bleeding, fistulas, or anastomotic complications are significantly reduced, while pain, wound complications, and recovery time are noticeably minimized for patients.
„Over the past two decades, the chances of truly curative treatment have improved significantly. Modern oncological and radiation therapy approaches—including antibody therapies—as well as the introduction of minimally invasive and robot-assisted surgical techniques have statistically increased survival rates. Robotics plays an important role in both esophageal and pancreatic surgery: it does not operate autonomously, but translates the surgeon’s precise movements with exceptional stability and minimal interference.
This reproducibility and high precision are crucial in complex procedures, as they reduce complications and improve the overall quality of surgery—a progress that is directly reflected in better outcomes for patients“, emphasizes Prof. Dr. Bockhorn.
The treatment decision is based on a combination of many factors: tumor stage, anatomical location, biological aggressiveness, functional risks, comorbidities, and individual resilience. This is precisely why these diseases are treated in specialized centers, where multiple disciplines work closely together alongside surgery. Only in this way can a concept be developed that equally considers oncological safety, functional preservation, and quality of life.
Optimal care for patients with diseases of the esophagus and pancreas can only be achieved where diagnostics, therapy, and follow-up are not viewed as separate steps, but as a closely integrated, interdisciplinary chain. These diseases are complex, often aggressive, and affect anatomically highly sensitive regions—therefore requiring structures in which different specialties work not sequentially, but simultaneously and collaboratively.
„After surgery of the esophagus or pancreas—often combined with pre- or postoperative oncological therapy—patients enter a phase of adaptation. Due to reconstruction, food intake changes: some can initially only eat small amounts, others no longer tolerate certain foods or develop new preferences and aversions. It is important to actively engage with this new situation and find out what works best individually. At the same time, daily life should be resumed as quickly as possible, including moderate physical activity, to stabilize strength and health.
During follow-up, treating physicians see their patients regularly at first, before further care is transferred to primary care physicians. In case of uncertainty or new symptoms, the hospital remains available at any time—following the principle of “once treated, always guided.” Overall, more men than women continue to be affected, which is related both to genetic factors and to risk behaviors that are more common among men“, states Prof. Dr. Bockhorn, concluding our conversation with the following remark:
„Oldenburg is the third university medical center in Lower Saxony and therefore assumes the corresponding responsibility for regional care. Another distinguishing feature is that around 50 esophageal and approximately 70 pancreatic tumor surgeries are performed here annually—a volume that underscores the high level of specialization and experience of the center“.
Thank you very much, Professor Dr. Bockhorn, for this valuable insight into your work!
- Director of the University Clinic for General and Visceral Surgery, Klinikum Oldenburg
- Professor of Visceral Surgery, Head of the Colorectal Cancer Center & ZIRCOL
- Specialist in esophagus, pancreas, heartburn, esophageal diverticula, and esophageal cancer
- Leader in minimally invasive, robotic, and oncological surgery
- Board-certified in visceral, advanced visceral, thoracic, and general surgery
- Former senior position at UKE Hamburg-Eppendorf
- International affiliations: E-AHPBA, ISGPS, ESA
- Research in tumor development, inflammation & chemoresistance; development of innovative polymer technologies
- Initiator of the robotic surgery center ZIRCOL & 24/7 telemedicine center
- Advocates organ-preserving, gentle high-end surgery at a university level
