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Trends and outcomes in colorectal cancer surgery: a multicenter cross-sectional study of minimally invasive versus open techniques in Germany

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Název: Trends and outcomes in colorectal cancer surgery: a multicenter cross-sectional study of minimally invasive versus open techniques in Germany
Autoři: Andreas Krieg, Ernst W. Kolbe, Michael Kaspari, Sarah Krieg, Sven H. Loosen, Christoph Roderburg, Karel Kostev
Zdroj: Surg Endosc
Informace o vydavateli: Springer Science and Business Media LLC, 2024.
Rok vydání: 2024
Témata: Length of Stay/statistics, Aged, 80 and over [MeSH], Aged [MeSH], Colorectal Neoplasms/surgery [MeSH], Postoperative Complications/epidemiology [MeSH], Colorectal cancer, Hospital Mortality [MeSH], Germany/epidemiology [MeSH], Male [MeSH], Robot-assisted surgery, Postoperative Complications/etiology [MeSH], Robotic Surgical Procedures/methods [MeSH], Minimal invasive surgery, Female [MeSH], Laparoscopy/methods [MeSH], Minimally Invasive Surgical Procedures/methods [MeSH], Adult [MeSH], Humans [MeSH], Treatment Outcome [MeSH], Middle Aged [MeSH], Cross-Sectional Studies [MeSH], Laparoscopy/statistics, Laparoscopic surgery, Article, Colorectal Neoplasms/pathology [MeSH], Robotic Surgical Procedures/statistics, Colorectal surgery, Male, Adult, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Robotic Surgical Procedures, Germany, Humans, Minimally Invasive Surgical Procedures, Hospital Mortality, Aged, Aged, 80 and over, Middle Aged, Length of Stay, 3. Good health, Cross-Sectional Studies, Treatment Outcome, Female, Laparoscopy, Colorectal Neoplasms
Popis: Background The objective of this study was to assess the trend from open to modern minimally invasive (laparoscopic and robot-assisted) surgical techniques for colorectal cancer (CRC) in Germany, with a particular focus on hospital mortality, postoperative complications, and length of hospital stay. Methods A multicenter cross-sectional study was conducted using data from 36 German hospitals, encompassing 1,250,029 cases from January 2019 to December 2023. The study included all hospitalized patients aged ≥ 18 with CRC who underwent surgery. Surgical cases were categorized as open or minimally invasive. Outcomes assessed included in-hospital mortality, morbidity, and hospital length of stay. Statistical analyses involved multivariable logistic and linear regression models adjusted for main diagnosis, metastasis presence, age, sex, and comorbidities. Results The study included 4525 CRC cases: 2767 underwent open surgery and 1758 underwent minimally invasive surgery (173 robotic). In-hospital mortality was significantly higher in open surgery (6.1% vs. 1.7%). Open surgery was also significantly associated with higher rates of acute post-hemorrhagic anemia (OR: 2.38; 95% CI: 1.87–3.02), respiratory failure (OR: 1.71; 95% CI: 1.34–2.18), and intraoperative and postprocedural complications (OR: 3.64; 95% CI: 2.83–4.70). Average hospital stay was longer for open surgery (19.5 days vs. 11.0 days). Conclusion Despite the advantages of minimally invasive surgery, including reduced mortality, morbidity, and shorter hospital stays, open surgery remains the predominant approach for CRC in Germany. These findings underscore the need for increased adoption of minimally invasive techniques and highlight the potential benefits of shifting toward minimally invasive methods to enhance the overall quality of CRC care. Graphical abstract
Druh dokumentu: Article
Other literature type
Popis souboru: application/pdf
Jazyk: English
ISSN: 1432-2218
0930-2794
DOI: 10.1007/s00464-024-11210-1
Přístupová URL adresa: https://pubmed.ncbi.nlm.nih.gov/39210061
https://pub.uni-bielefeld.de/record/2992374
https://doi.org/10.1007/s00464-024-11210-1
https://repository.publisso.de/resource/frl:6521333
Rights: CC BY
Přístupové číslo: edsair.doi.dedup.....472dbccfd3c40c4bda17027e936f53e8
Databáze: OpenAIRE
Popis
Abstrakt:Background The objective of this study was to assess the trend from open to modern minimally invasive (laparoscopic and robot-assisted) surgical techniques for colorectal cancer (CRC) in Germany, with a particular focus on hospital mortality, postoperative complications, and length of hospital stay. Methods A multicenter cross-sectional study was conducted using data from 36 German hospitals, encompassing 1,250,029 cases from January 2019 to December 2023. The study included all hospitalized patients aged ≥ 18 with CRC who underwent surgery. Surgical cases were categorized as open or minimally invasive. Outcomes assessed included in-hospital mortality, morbidity, and hospital length of stay. Statistical analyses involved multivariable logistic and linear regression models adjusted for main diagnosis, metastasis presence, age, sex, and comorbidities. Results The study included 4525 CRC cases: 2767 underwent open surgery and 1758 underwent minimally invasive surgery (173 robotic). In-hospital mortality was significantly higher in open surgery (6.1% vs. 1.7%). Open surgery was also significantly associated with higher rates of acute post-hemorrhagic anemia (OR: 2.38; 95% CI: 1.87–3.02), respiratory failure (OR: 1.71; 95% CI: 1.34–2.18), and intraoperative and postprocedural complications (OR: 3.64; 95% CI: 2.83–4.70). Average hospital stay was longer for open surgery (19.5 days vs. 11.0 days). Conclusion Despite the advantages of minimally invasive surgery, including reduced mortality, morbidity, and shorter hospital stays, open surgery remains the predominant approach for CRC in Germany. These findings underscore the need for increased adoption of minimally invasive techniques and highlight the potential benefits of shifting toward minimally invasive methods to enhance the overall quality of CRC care. Graphical abstract
ISSN:14322218
09302794
DOI:10.1007/s00464-024-11210-1