Department of General and Visceral Surgery, Thoracic Surgery and Proctology, Medical Campus OWL, University Hospital Herford, Ruhr University Bochum, Schwarzenmoorstr. 70, 32049, Herford, Germany.
Department of Inclusive Medicine, University Hospital Ostwestfalen-Lippe, Bielefeld University, 33617, Bielefeld, Germany.
Surg Endosc. 2024 Nov;38(11):6338-6346. doi: 10.1007/s00464-024-11210-1. Epub 2024 Aug 29.
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.
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.
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).
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.
本研究旨在评估德国结直肠癌（CRC）从开放式到现代微创（腹腔镜和机器人辅助）手术技术的趋势，重点关注医院死亡率、术后并发症和住院时间。
本研究采用来自德国 36 家医院的多中心横断面研究数据，纳入 2019 年 1 月至 2023 年 12 月期间所有年龄≥18 岁、接受 CRC 手术的住院患者。手术病例分为开放式或微创式。评估的结果包括院内死亡率、发病率和住院时间。统计学分析采用多变量逻辑回归和线性回归模型，调整了主要诊断、转移存在、年龄、性别和合并症。
本研究共纳入 4525 例 CRC 病例：2767 例行开放式手术，1758 例行微创式手术（173 例机器人手术）。开放式手术的院内死亡率显著更高（6.1% vs. 1.7%）。开放式手术还与更高的急性术后失血性贫血发生率（OR：2.38；95% CI：1.87-3.02）、呼吸衰竭发生率（OR：1.71；95% CI：1.34-2.18）和术中及术后并发症发生率（OR：3.64；95% CI：2.83-4.70）相关。开放式手术的平均住院时间更长（19.5 天 vs. 11.0 天）。
尽管微创手术具有降低死亡率、发病率和缩短住院时间的优势，但开放式手术仍是德国 CRC 的主要治疗方法。这些发现强调了增加微创技术应用的必要性，并突显了向微创方法转变以提高 CRC 整体护理质量的潜在益处。
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