Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2024 Nov;38(11):6338-6346.
doi: 10.1007/s00464-024-11210-1. Epub 2024 Aug 29.

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

Andreas Krieg  1 , Ernst W Kolbe  2 , Michael Kaspari  2 , Sarah Krieg  3 , Sven H Loosen  4 , Christoph Roderburg  4 , Karel Kostev  5
Affiliations
Comparative Study

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

Andreas Krieg et al. Surg Endosc. 2024 Nov.

Abstract

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.

Keywords: Colorectal cancer; Colorectal surgery; Laparoscopic surgery; Minimal invasive surgery; Robot-assisted surgery.

PubMed Disclaimer

Conflict of interest statement

Prof. Andreas Krieg, Dr. Ernst-Wolfgang Kolbe, Michael Kaspari, Dr. Sarah Krieg, Prof. Sven Heiko Loosen, Prof. Christoph Roderburg, and Prof. Karel Kostev have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Selection of study patients
Fig. 2
Fig. 2
Proportion of CRC patients with open and minimal invasive surgery (%)
See this image and copyright information in PMC

References

    1. Robert Koch-Institut (Hrsg) und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. (Hrsg) (2023) Krebs in Deutschland für 2019/2020. 14. Ausgabe, Berlin
    1. Cooperman AM, Katz V, Zimmon D, Botero G (1991) Laparoscopic colon resection: a case report. J Laparoendosc Surg 1:221–224 - DOI - PubMed
    1. Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1:144–150 - PubMed
    1. Schwenk W, Haase O, Neudecker J, Müller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev. 10.1002/14651858.CD003145.pub2 - DOI - PMC - PubMed
    1. Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ (2008) Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev. 10.1002/14651858.CD003432.pub2 - DOI - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources