Fehler und Gefahren: Onkochirurgie im Kopf-Hals-Bereich

Zusammenfassung

Die chirurgische Therapie ist einer der grundlegenden Bausteine in der Behandlung von Patienten mit Karzinomen im Kopf-Hals-Bereich. Fehler in der chirurgischen Behandlung können schwerwiegende Konsequenzen für die betroffenen Patienten haben. Dies gilt für funktionelle postchirurgische Beschwerden bis hin zur Beeinträchtigung der Chancen für das Gesamtüberleben. Dabei gibt es zahlreiche Gefahrenquellen, die derartige Fehler hervorrufen können.

Grundlage einer Fehler vermeidenden chirurgischen Therapie ist zunächst eine sorgfältige präoperative Vorbereitung. Dies gilt u.a. für die Einschätzung der Operabilität, die Beurteilung der erfolgten Diagnostik und die operative Planung. Das anschließende Vermeiden von Fehlern wird nicht zuletzt erreicht durch umfassende Kenntnisse der anatomischen Besonderheiten im Kopf-Hals-Bereich, der aktuellen Daten- und Studienlage sowie durch die Befähigung moderner chirurgischer Techniken. Unterstützt wird dies durch eine stets kritische Einschätzung des persönlichen Handelns des jeweiligen Chirurgen. Auch Aspekte der Ernährung und des Wundmanagements sowie der kenntnisreiche Umgang mit möglichen Komplikationen helfen, Fehler zu minimieren.

Trotz aller präventiver Maßnahmen und chirurgischer Sorgfalt sind Fehler durch den Chirurgen nicht grundsätzlich vermeidbar. Daher ist nicht zuletzt auch der regelrechte Umgang mit Fehlern, eine gute Fehlerkommunikation und ein entsprechendes Management von großer Bedeutung für das ärztliche Handeln. Das Manuskript gibt entsprechende Hinweise für die Prävention von Gefahrenquellen und Fehlern in der präoperativen, operativen und in der postoperativen Phase der Behandlung von Kopf-Hals-Karzinompatienten

Abstract

Surgical Errors and Risks – the Head and Neck Cancer Patient

Head and neck surgery is one of the basic principles of head and neck cancer therapy. Surgical errors and malpractice can have fatal consequences for the treated patients. This can lead into functional impairment and even have impact in future chances for disease related survival. There are many risks for head and neck surgeons which can cause errors and malpractice.

To avoid surgical errors, thorough preoperative management of patients is demanded for. Such is ensuring operability, cautious evaluation of preoperative diagnostics and operative planning. Moreover knowledge of anatomical structures of the head and neck, of medical studies and data as well as qualifications in modern surgical techniques and the surgeons ability for critical self assessment are basic but important prerequisites for head and neck surgeons in order to prevent from mistakes. Moreover it is important to have profound knowledge in nutrition management of cancer patients, wound healing and to realize and be capable of dealing with complications, when they occur.

Despite all preventive precaution and surgical care, mistakes cannot always be avoided. For that it is important to be able to deal with errors and to establish an appropriate and clear communication and management for such events. The manuscript comments on recognition and prevention of risks and mistakes in the preoperative, operative and postoperative phase of head and neck cancer surgery.

Schlüsselwörter

Onkologie - Kopf-Hals-Chirurgie - Fehler - Gefahren - Fehlerprävention

Key words

oncology - head and neck surgery - surgical error - surgical risk - prevention of surgical error

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