Interview with Prof. Dr. Dr. Markus W. Büchler, Spokesman of the Surgical University Hospital and Medical Director of the Clinic for General, Visceral and Transplant Surgery, and Prof. Dr. Dirk Jäger, Managing Director of the National Center for Tumor Diseases (NCT) Heidelberg. The specialist talk about the close collaboration of both institutions in treating cancer patients as well as new, individualized therapies and future challenges.

Annually, around 4,000 patients are operated at Heidelberg University Hospital. What many outsiders do not suspect: The vast majority - around two thirds of them - are tumor patients. An important partner of the Heidelberg Surgery Center is therefore the National Center for Tumor Diseases (NCT), which was founded by the University Hospital together with the German Cancer Research Center and German Cancer Aid. The NCT is a nationwide point of contact for cancer patients, where individual treatment plans are developed that can be carried out at the Heidelberg Day Clinic. The central organ is the interdisciplinary tumor board, where oncologists, surgeons and other specialists regularly discuss the best possible therapy for their patients and plan the next steps.

Tumor therapy as a "team sport" - how is that to be understood?

Prof. Büchler:

The team spirit is crucial, because only together we can achieve an optimal result for our patients. Today, almost every third cancer patient is operable - but often it is not done with a surgical intervention alone. In most cases different approaches are necessary. For example, tumors that are too large or unfavorably located are first reduced in size by medication or radiotherapy, and then removed permanently. The oncologists are also responsible for the drug-based follow-up treatment, which is indispensable for many patients who have undergone surgery.

Prof. Jäger:

NCT and surgery are also an example of a particularly successful collaboration between research and practice. The majority of our patients - over 60 percent - take part in clinical studies. In order to answer the associated research questions, we need tumor material and appropriate examinations. We only get this by working with a strong, scientifically experienced partner like Heidelberg Surgery. After all, our goal is not treatment according to standards - we want real innovations to succeed, and that can only be achieved as a team.

You have been close cooperation partners for many years, but now you are also moving closer together. What advantages does this bring for the treatment of cancer patients?

Prof. Büchler:

In the new surgery we have shorter distances, excellent medical technology and innovative care options. Everything is closer together, for example, the intensive care unit is located directly next to the operating rooms. The building was designed to provide the best possible conditions for patients and staff. The rooms are more comfortable and the infrastructure is better. The new surgical clinic is a huge step forward for everyone.

Prof. Jäger:

Another advantage: clinics and NCT are now connected with a tunnel system. Previously, we had to bring ill patients to the surgery by car or by ambulance. In the future, patients will be able to be driven in their beds from one house to another.

What distinguishes the Heidelberg Medical Campus for you?

Prof. Jäger:

We treat courageously and make decisions after thorough examination, but quickly. The close interdisciplinary coordination and the enabling of quick procedures are extremely important for patients who find themselves in a psychologically stressful situation. In terms of treatment quality, we are among the world's best.

Prof. Büchler:

To put it in a nutshell: We are already quite good here. Heidelberg justifiably has an excellent reputation as a research and treatment center in cancer medicine. Word gets around and this is the reason for the excellent international reputation of this location. For example, we are the largest clinic for pancreatic surgery in the world and we are very proud of it.

Has the willingness of patients to participate in research projects changed?

Prof. Jäger:

Absolutely. In the past, many patients feared of being considered a "test participant/test subject" when it came to unapproved experimental therapies. Today we see many patients who come to Heidelberg specifically to participate in an innovative study.

Prof. Büchler:

Today, many patients have great confidence in modern cancer medicine. They are therefore open to new therapeutic approaches that at least offer them a chance.

The NCT is conducting intensive research into new therapies. Will these be able to replace surgical removal of tumors at some point?

Prof. Büchler:

For many years now I have been confronted with the question "How long will oncological surgery be around? About 30 years ago, I was somewhat preoccupied with this question, but in the meantime I am at ease. In the case of tumors, the removal of cancerous tissue is still a very important matter, so surgery will be around for a few more years.

Prof. Jäger:

We will certainly become more effective in different disease situations with drug, immunotherapeutic or radiotherapeutic approaches, but still it will not work without surgery. I would like to give two examples of this: Firstly, in contrast to the past, we have an increasing number of patients who benefit from surgical interventions even when metastases occur - a development for which we and the patients are very grateful. And secondly, even when we apply new therapies that are tailored precisely to the patient, we still need the tumor in order to know our opponent exactly. Without tumor cells, an individualized therapy is not possible - and we get these cells with the help of surgery.

Keyword individual therapy: How can this be ensured in the interaction of two such large hospitals?

Prof. Büchler:

This is not a problem, but a management issue. If you are well and professionally organized in management, then every patient gets what he or she needs. The clinics must be set up in such a way that there are enough doctors and nurses.

Prof. Jäger:

We have about 200 to 240 outpatients every day and many patients in the day clinics. Despite high numbers, we want to offer patient-oriented processes. This is not always easy, but it is feasible and I think we are already doing quite well.

Prof. Jäger, if you could grant your "team partner" Prof. Büchler three wishes for the start in the new building - what would you wish him?

Prof. Jäger:

I wish him that modern surgery can be implemented much better in the new building and that our excellent cooperation will be even more uncomplicated, so that we can implement a whole range of innovative concepts together