Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, Netherlands.
Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, Netherlands.
Surg Endosc. 2022 Aug;36(8):5986-6001. doi: 10.1007/s00464-021-08974-1. Epub 2022 Mar 8.
The timing and degree of implementation of minimally invasive surgery (MIS) for colorectal cancer vary among countries. Insights in national differences regarding implementation of new surgical techniques and the effect on postoperative outcomes are important for quality assurance, can show potential areas for country-specific improvement, and might be illustrative and supportive for similar implementation programs in other countries. Therefore, this study aimed to evaluate differences in patient selection, applied techniques, and results of minimal invasive surgery for colorectal cancer between the Netherlands and Sweden.
Patients who underwent elective minimally invasive surgery for T1-3 colon or rectal cancer (2012-2018) registered in the Dutch ColoRectal Audit or Swedish ColoRectal Cancer Registry were included. Time trends in the application of MIS were determined. Outcomes were compared for time periods with a similar level of MIS implementation (Netherlands 2012-2013 versus Sweden 2017-2018). Multilevel analyses were performed to identify factors associated with adverse short-term outcomes.
A total of 46,095 Dutch and 8,819 Swedish patients undergoing MIS for colorectal cancer were included. In Sweden, MIS implementation was approximately 5 years later than in the Netherlands, with more robotic surgery and lower volumes per hospital. Although conversion rates were higher in Sweden, oncological and surgical outcomes were comparable. MIS in the Netherlands for the years 2012-2013 resulted in a higher reoperation rate for colon cancer and a higher readmission rate but lower non-surgical complication rates for rectal cancer if compared with MIS in Sweden during 2017-2018.
This study showed that the implementation of MIS for colorectal cancer occurred later in Sweden than the Netherlands, with comparable outcomes despite lower volumes. Our study demonstrates that new surgical techniques can be implemented at a national level in a controlled and safe way, with thorough quality assurance.
微创外科（MIS）治疗结直肠癌的时机和程度在各国之间存在差异。了解在新技术应用方面的国家差异以及对术后结果的影响对于质量保证很重要，能够显示出特定国家的改进潜力，并可能为其他国家类似的实施计划提供参考和支持。因此，本研究旨在评估荷兰和瑞典在结直肠癌微创治疗中患者选择、应用技术和结果方面的差异。
纳入了在荷兰 ColoRectal Audit 或瑞典 ColoRectal Cancer Registry 中接受择期微创治疗 T1-3 期结肠癌或直肠癌的患者（2012-2018 年）。确定了 MIS 应用的时间趋势。比较了 MIS 实施水平相似的时间段（荷兰 2012-2013 年与瑞典 2017-2018 年）的结果。采用多水平分析确定与不良短期结果相关的因素。
共纳入了 46095 例荷兰和 8819 例瑞典接受结直肠癌 MIS 治疗的患者。在瑞典，MIS 的实施时间比荷兰晚了大约 5 年，机器人手术的比例更高，每个医院的手术量更低。尽管瑞典的转换率更高，但肿瘤学和手术结果相当。与瑞典 2017-2018 年相比，荷兰 2012-2013 年的 MIS 治疗结肠癌的再次手术率更高，直肠肿瘤的再入院率更高，但非手术并发症发生率更低。
本研究表明，瑞典结直肠癌 MIS 的实施时间晚于荷兰，尽管手术量较低，但结果相当。我们的研究表明，新的手术技术可以在国家层面上以受控和安全的方式实施，并进行彻底的质量保证。
