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Professor Jan Schmidt has chosen one of the most challenging surgical fields: abdominal (or visceral) surgery, with a particular focus on pancreatic cancer. Over his career, Professor Schmidt has performed more than 14,000 surgical procedures, not only on the pancreas but also on the liver, kidneys, intestine, and many other organs, organs that define our quality of life.
– Professor Schmidt, can you recall when and why you chose abdominal surgery? It is a tricky field in which you have to be an expert in practically all the systems of the body, and at the same time it requires incredible craftsmanship. What do you love most about your specialty?
– Abdominal surgery is beautiful and interesting because it involves many organs which are of vital importance to our body: the liver, responsible for detoxification; the pancreas, extremely important for digestion and blood sugar stabilization; and the intestinal tract, including such organs as the stomach and the small and large intestines, for the digestion of food; and, last but not least, the endocrine glands such as the adrenal gland. So it is versatile, fascinating, and extremely important. Something else which makes it interesting and challenging is the fact that you rarely perform the exact same procedure twice, since every human is different not only on the outside but also on the inside.
– You are an expert in pancreatic surgery, a rare thing. Can you explain why these operations are considered extremely difficult and risky?
– The pancreas is an organ that produces a range of enzymes and hormones. The enzymes, once activated, can digest any tissue in the human body, including our own tissue. The mechanisms behind this enzyme activation are not completely clear to medical professionals and scientists. But here is what we know for sure: it is of the utmost importance that the pancreas is handled with great care. If you eat a steak, the pancreatic enzymes can digest the piece of meat within a few hours, breaking it down into atoms. If this occurs after a surgical operation, the enzymes can destroy the patient’s own organs, blood vessels, etc. This is why this organ is so very special and you need to have a lot of experience to minimize the complications.
– Pancreatic cancer has one of the highest mortality rates. Do you think that will ever change? Do you see any scientific advances in that area? What does your experience tell you?
– Yes, pancreatic cancer is still a lifethreatening disease, but a lot of advances have been made in recent years. Operative tactics and techniques have been refined, and there has also been a major improvement in the chemotherapy treatment that either precedes or follows the surgical procedure for pancreatic cancer. Nowadays treatments have become much more effective. In the latest clinical trials, up to 50% of patients who underwent pancreatic cancer resection have survived for 5 years or more, a number that wasn’t even imaginable a few years ago. So now we have much better options at hand for treating patients with this condition.
– What other conditions related to the pancreas can be treated surgically?
– As I’ve mentioned before, just as the pancreas can digest our food it can also harm itself by the premature activation of digestive enzymes. So we see quite a number of patients with alcohol-related problems – many of them develop chronic pancreatitis. This form of pancreatic inflammation can result in scarring and narrowing of the duct that leads the pancreatic juice into the intestine. Fluid collection and compression of other organs or damage to blood vessels can occur, and frequently an operation is necessary to remove the scar tissue and provide for the free outflow of pancreatic juice. This is a very effective procedure, especially for pain relief.
– How does the patient’s way of life and habits affect their pancreas?
– As already mentioned, high alcohol intake can lead to the onset of pancreatitis, with very negative consequences. But that is not the only factor: smoking also can cause the occurrence of cancerous masses in the pancreas. A smoker carries about four times the risk of developing pancreatic cancer compared to a non-smoker. Also, the consumption of red meat seems to be associated with a risk of cancer. On the other hand, long-time studies show that vegetables, green tea, and coffee help protect our body against pancreatic cancer.
– You often travel to other countries to perform transplants. In which situations do foreign clinics usually invite you? Can you tell us about some cases when your expertise was required?
– Liver, pancreas, and kidney transplants are frequently needed when the organ is failing. Take Egypt, for example. More than 12 million Egyptians suffer from hepatitis C and 10% of these patients develop liver cirrhosis. Many of those people either die or need a liver transplant if an organ donor is available. Since cadaveric organ transplantation, i.e. the transplant of organs from a recently deceased person, is not performed in Egypt due to the lack of any organ procurement system, we usually deal with living organ donation from relatives. I help with difficult cases of liver resection and liver transplants, especially in children. I mostly work in the Nile Delta.
Another condition that can cause disaster is kidney failure in children. I often travel to Georgia to help perform kidney transplants, usually from a parent to their child. This procedure can help young patients to avoid dialysis treatment and achieve an almost normal quality of life after recovery. In one very dramatic case, we were recently able to help a five-year-old girl called Nathaly to fully recover from a life-threatening nephroblastoma.
– In some surgical fields, technological advances have really changed the rules of the game. What have been the latest advances in abdominal surgery regarding new equipment and techniques over the past, let’s say, five years?
– There have indeed been a lot of technical advances. Take, for example, techniques for transecting liver tissue. In the past, this was a difficult and blood-consuming procedure. Nowadays we have modern sealing devices, staplers, and hemostatic agents that allow us to take part of the liver without a blood transfusion. Robotic techniques have been developed, such as the da Vinci system, that allow for highly precise movements in narrow, difficult-to-reach areas. Also, there are new organ preservation techniques and minimally invasive approaches that facilitate a less traumatic operation with better postoperative function.
Professor Jan Schmidt
Professor Schmidt worked for 30 years at the University Clinic of Heidelberg, one of the largest and most renowned medical centers in Germany, before transferring to Switzerland in 2011 and joining the team at the world-famous Hirslanden Klinik Im Park in Zurich. The special focus of Prof. Schmidt’s medical work has been on complex operations in the area of the pancreas, the liver, and the entire digestive tract. As head of transplantation surgery, Professor Schmidt has performed liver, kidney, and pancreas transplants, including live liver donations in children and adults, for more than 10 years. His charity work includes stints in Georgia, Egypt, Romania, and many other countries. In 2015 Professor Schmidt founded Swiss Surgery, an organization uniting some of the country’s top surgeons in the battle against cancer. Prof. Schmidt is a member of the Swiss Society of Surgery (SGC), the American Pancreatic Association Inc., and the Pancreas Club Inc.