Due to their increased detection pancreatic cystic space-occupying lesions are becoming increasingly relevant in the clinical routine and represent a morphologically and biologically heterogeneous and thus clinically demanding as well as potentially (pre)malignant entity. As a result, recommendations for the diagnostics and treatment of pancreatic cystic tumors have now been incorporated into the current German S3 guidelines on pancreatic cancer. The diagnostics of pancreatic cystic space-occupying lesions are based on the following three elements: collection of relevant clinical information, performance of high-resolution imaging procedures and if diagnostic uncertainty persists, puncture diagnostics. Differentiated diagnostics are of essential importance as these represent the basis for an adequate treatment decision. Pancreatic cystic lesions with a relevant risk of malignant transformation, e.g., main duct intraductal papillary mucinous neoplasms (IPMN), followed by mucinous cystic neoplasms (MCN), solid pseudopapillary neoplasms (SPN) and generally pancreatic cystic lesions with risk factors independent of the entity, should be resected, whereas a differentiated and individualized approach is necessary, especially for branch-duct IPMNs. The serous cystic neoplasms (SCN) have no malignant potential and do not require any treatment if they are asymptomatic. Important principles in surgery of pancreatic cancer, such as adequate surgical resection taking oncological standards into account and standardized appropriate histopathological processing of the specimens as well as intraoperative frozen section analysis also play an important role in pancreatic cystic space-occupying lesions. An annual follow-up seems to be meaningful, especially for IPMNs.

The minimum case volume regulations of the Federal Joint Committee determine the size of the respective annual minimum number for each site of a hospital, for selected scheduled inpatient services where the quality of the treatment results is dependent on the number of services carried out. In addition, further details on the elucidation of the prognosis are determined in the regulations. Due to the legally defined prognostic procedure as a prerequisite for a prospective justification for service provision, new or altered minimum case volumes come into effect even before the end of the validity period established on the justification for provision of services. The Federal Joint Committee established this basic principle also for the introduction procedure in a resolution from 16 December 2021. This article explains the background and should support the implementation.

The new German S3 guidelines on ductal pancreatic adenocarcinoma were published for the first time on the homepage of the Association of the Scientific Medical Societies in Germany (AWMF) in December 2021 as a new update and thus the second update (first update 2013) and contain a large number of innovations in terms of diagnostics and treatment. The guidelines were organized and led by the German Society for Digestive and Metabolic Diseases (DGVS). In this article we would like to present the central content and innovations related to the radiological diagnostics of ductal pancreatic adenocarcinoma. The most important innovations are the highest recommendation strength in favor of computed tomography (CT) when assessing tumor spread as well as the adaptation of the European guidelines for cystic tumors by magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) as the method of first choice. A further innovation is the implementation of a structured reporting of CT findings for describing the anatomical tumor resectability on the basis of the publication presented by the Abdominal Imaging Working Group and the Oncological Imaging Working Group of the German Radiological Society. There is no evidence for the implementation of radiological imaging in the field of aftercare or in the field of screening.

Acute pancreatitis is a primary sterile inflammation of the pancreas, which is characterized by an unphysiological enzyme activation. This leads to an inflammatory reaction with edema, vascular damage and cell decay. The first German interdisciplinary S3 guidelines on chronic pancreatitis were published in 2012. Under the auspices of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) and with the participation of various societies and patient representatives, the guidelines were recently revised and extended, Comprehensive S3 guidelines on acute and chronic pancreatitis were compiled and agreed by consensus. This article presents the important clinical aspects on acute pancreatitis from these guidelines in a compact form and the recommendations are justified.

The association between patient volume and treatment quality has been sufficiently proven for certain surgical interventions (e.g., resections of the esophagus and pancreas). International experience shows that centralization of patient care in these fields leads to an improvement in outcome quality. If properly enforced, minimum caseload requirements can induce centralization effects in the hospital market. Overcapacities in the German hospital market and high nationwide in-hospital mortality rates (e.g., nationwide postoperative hospital mortality after esophageal and pancreatic resections) justify the current changes in the minimum caseload requirement regulation. Nevertheless, still open questions on volume-outcome relationships (e.g., additive volume effects of associated organ systems) have yet to be answered by scientific studies. In addition, the special role of university medical centers in the German healthcare system needs to be considered in the minimum caseload requirement regulation in order not to jeopardize the importance of university clinics in science, education and patient care through self-regulatory processes in the hospital market induced by minimum caseload requirements.

Minimum caseload requirements represent a regulatory instrument of the Federal Joint Committee in order to improve patient safety for elective, highly complex procedures or treatments. A relationship between case volume and quality of the outcome must be demonstrated within the scientific literature before minimum caseload requirements can be implemented. Furthermore, patients need to be allocated to hospitals which perform higher case volumes but without causing temporal and/or transport distress for them. The recent Health Care Development Act has opened up new opportunities to combine minimum caseload requirements with each other along with structure, process and outcome quality. The surgical community can provide a contribution to this structuring process.

The scientifically founded surgical specialist discussion regarding the legal requirements for minimum volume numbers for diverse organ systems and selected surgical procedures as the basis of quality assurance and optimization of treatment is not new. Comprehensive and also reliable data from national and international studies are available for colorectal surgery, pancreatic surgery, esophageal surgery, liver surgery and gastric surgery. Recently, the raising of the minimum volume for complex esophageal interventions by the Federal Joint Committee (G-BA) in Germany from 10 up to 26 procedures per hospital and year, reignited the debate on this topic as well as the debate on centralization in the healthcare system in general. This decision seems to be scientifically well-justified from the perspective of political bodies and realizable in the practical implementation; however, from the perspective of physicians routinely involved in the corresponding highly complex procedures, there is a very much broader basis for discussion, which is only partially covered by a report of the Institute for Quality and Efficiency in the Healthcare System (IQWiG) as the foundation of the decision of the G‑BA. For the scientifically oriented surgical specialist society, in the first instance priority is given to the scientific evidence as the guiding principle. Nevertheless, aspects of the treatment reality cannot and should not be ignored. Therefore, the recommendations of the specialist society must be oriented not only to the quality of results but also to the realistic options for successful implementation in practice. Furthermore, questions of further education, the right of the patient to freedom of choice of the physician and preservation of the attractiveness of the occupational profile of surgeons are immanent topics for the surgical specialist society.