Since the inception of Amsterdam UMC, specific expertise and specialized patient care is being centralized at either the De Boelelaan or Meibergdreef location. After a six month COVID-delay, the third and biggest reorganization ‘wave’ took place in June 2021. Surgeon Marc Besselink, Professor of Pancreatic and Hepatobiliary (HPB) Surgery, shares his insights on the importance of centralizing care for patients, working together, and aiming for the ‘Champions League’ of oncological care.

Among the largest oncology centers in Europe
“The third wave was the largest one yet at Amsterdam UMC,” begins Prof. Besselink. ”Among other department mergers happening, all expertise and care of liver, gallbladder, and pancreatic disease (HPB) was centralized at our De Boelelaan location. This involved dozens of medical oncologists, gastroenterologists, surgeons, pathologists, nurse specialists, physician assistants, surgical scrub nurses, specialized ward nurses, endoscopy nurses, oncology nurses, dieticians, physical therapists, PhD students, et cetera, et cetera...and, not to forget, two surgical robots.”

The HPB surgery team is now located in close proximity to their colleagues of the upper gastrointestinal (UGI) surgery team, making the De Boelelaan location now one of the largest oncology centers for these types of surgery in Europe.

Why centralize? Marc Besselink explains: “Some people may not see the importance of centralizing care or even fear one big ‘factory-like’ hospital. But the opposite is true! Yes, following the centralization we do see more HPB patients, almost 20 new patients every week…that is going to be close to a 1000 patients with liver, gallbladder or pancreas related diseases this year. But it is because we see so many and more complex patients that we can address the specific needs of each patient within highly specialized care teams, including nurse specialists.”

It is because we see so many complex patients that we can address the specific needs of each patient within highly specialized care teams.” Prof. Marc Besselink.

Super Specialists
“Just twenty years ago, one specialist would see and treat patients with all gastrointestinal diseases. But with the current pace of medical advances, it is impossible for a single medical professional to keep up to date and provide care according to all the latest insights. You need a specialized team.” Therefore, the patients at Amsterdam UMC are cared for by highly dedicated and personalized medical teams. Each week, 10 distinct multidisciplinary HPB discussion meetings take place, each focused on patients with different conditions. Prof. Besselink: “This highly personalized and specialized care is made possible by the merger. For example, I am fully dedicated to patients requiring pancreatic surgery, while other colleagues specialize in gallbladder, or liver, or metastasized colorectal cancer. The focus of our surgeons on one particular surgical area creates value, as they perform complex but similar procedures over and over again leading to better outcomes for our patients”.      

Care pathways and regional collaborations
Together with colleagues at regional hospitals, the Amsterdam UMC specialists have developed seven distinct regional gastrointestinal oncological care pathways for patients. These care pathways are essential for achieving and maintaining high quality and uniform standards of care at our center and hospitals throughout the region. The care pathway also stipulates which patients will benefit from a referral to “super specialists” at Amsterdam UMC and which do not. “This is really important,” says Prof. Besselink. “This means we are not caring for patients who can easily obtain effective treatments at local medical centers. Because of the care pathways, we have a clear understanding with local hospitals so we can focus on doing our specialty: complex interventions at the right time”.

“A patient with pancreatic cancer, on whom we operated last week, is a good example of our current standard of care. This patient’s tumor enclosed a vital blood vessel. Five years ago, surgery would not have even been possible. But now, the patient’s tumor was successfully removed during an operation involving three highly specialized surgeons. These complex treatments require a multidisciplinary approach, starting with chemotherapy to reduce tumor size before the operation and a detailed assessment of the effect of this treatment. Also, during surgery our interventional radiologists provide real-time ultrasound images for surgical guidance. When I informed the patient’s family the procedure was successful, their response was just beyond joy and happiness. The survival outlook of this patient is twice as good as for a smaller tumor 10 years ago.”

Research and Education
And what impact does the centralization of care have on education or research? “The centralization provides a huge impulse to research and education. First of all, because we care for many more patients, we have many more opportunities to learn. For instance, if you do a certain surgical procedure only 15 times a year, a surgeon is unlikely to notice distinct patterns or occasional peculiarities. However, when you do that same procedure two or three times per week, you are much more likely to recognize and document specific details or problems, and then you start to see trends and potential solutions much sooner.” Patients also contribute in research and education, Prof. Besselink says. “More patients also mean more participation. So many are eager to help, from donating blood samples or taking part in a clinical trial.”

In light of education and professional advancement, Prof. Besselink says: “Centralization has brought 90 research physicians (‘arts-onderzoekers’) in upper gastrointestinal and HPB surgery together, sharing offices in the same hallway. This greatly enhances the interactions among each other and with our super specialists, so they can exchange experiences and gain knowledge.”

Champions League
Medical research and clinical care standards offered in Amsterdam were already greatly respected internationally, according to Prof. Besselink. He sees that the centralization of care, research, and education through merging departments at Amsterdam UMC will facilitate the next key advancements. “When your organization is too small, you are quickly overlooked by potential partners these days. To advance and innovate, you need to be part of a big organization. Only then can you gain the expertise and team up with other state-of-the-art institutes across Europe and worldwide to acquire essential funding and participate in important clinical trials. We owe it to our patients to be in the ‘Champions League’ of medical care!”