Everyone can learn from one another

Prof. Falk Bechara coordinated a study with 45 sites worldwide

High-quality patient care is one of the most important tasks of any university hospital, but so is research. Studies that are conducted internationally at multiple sites (multicentre studies) instead of only at a single site are particularly important. Do we really need 45?

“Yes, it was challenging to deal with such a high number of sites“, says Prof. Falk Bechara, Chief Consultant and Head of Dermatosurgery at the University Department of Dermatology at St. Josef Hospital in Bochum (Director: Prof. Eggert Stockfleth). He specialises in performing surgery for acne inversa, one of the most serious skin diseases. It is extremely painful and causes enormous psychological suffering.

The centre in Bochum is one of the global leaders in this type of surgery. This was the backdrop against which Falk Bechara, as the lead author, coordinated a study involving 45 sites in 20 countries on all continents. The results were published in the renowned JAMA Surgery, the world’s leading surgical journal.

The study specifically focused on adalimumab, a standard anti-inflammatory medication. This medication is also approved for the treatment of other diseases, such as rheumatic arthritis, or chronic inflammatory bowel diseases, such as ulcerative colitis or Crohn’s disease. However, until now, it was not clear whether adalimumab should be discontinued before surgery to treat acne inversa. Result of the four-year study: It is effective both before and after surgery, as well as being safe. Professor Bechara sees this result as a milestone, because it improves the healing process for many people.

It was very difficult to recruit patients for this study. This was not because acne inversa is extremely rare – in fact, there are several hundred thousand patients in Germany alone.

Instead, the fact that surgery for acne inversa is not performed by dermatologists, but by various other surgeons, such as visceral or plastic surgeons, who often use different surgical techniques to treat acne inversa, e.g. variation in the surgical extent or incision margins, etc., proved to be the ultimate obstacle.

However, it was essential for this study to adopt a standardised approach, which complicated both the selection of eligible sites and of participating patients. Ultimately, 200 patients were selected, 20 of them in Bochum alone. “One of my main tasks was to provide site training on surgical treatment. This communication sometimes took an enormous amount of time“, says Prof Bechara. However, it ended up being the decisive factor: Ultimately, the fact that the study results were not distorted by excessive surgical heterogeneity had to be guaranteed.

All patients were examined twelve weeks before and twelve weeks after surgery. The measurements included examination for wound healing disorders, bleeding complications, development of infection and pain perception. Quality of life was also assessed using an internationally validated and recognised evaluation form.

Interdisciplinary collaboration has become a decisive factor in modern medicine. This study shows how this was impressively achieved in the fields of dermatology and surgery, quite independently of the fact that it also demonstrated the efficacy and safety of a single medication from a new perspective. Professor Bechara believes that the result also provides important food for thought beyond the two disciplines directly involved: “Simply stated, it’s all about keeping an open mind to other people’s ideas. Everyone can learn from one another.”

In this case, it was surgeons and dermatologists. A good surgeon knows that a scalpel alone does not bring about healing. And conversely, a good dermatologist will realise that surgery is necessary under certain conditions. Communication is the key to success.