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Versorgungsrealität in der laparoskopischen Chirurgie des Kolonkarzinoms in Deutschland

Treatment reality with respect to laparoscopic surgery of colonic cancer in Germany

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Zusammenfassung

Hintergrund

Prospektiv randomisierte Studien und Metaanalysen haben gezeigt, dass die laparoskopische Kolonkarzinomresektion der offenen Resektion hinsichtlich der onkologischen Ergebnisse gleichwertig ist und kurzfristige Vorteile im früh-postoperativen Outcome hat. Mit der vorliegenden Analyse wurde untersucht, ob sich die laparoskopische Kolonresektion in der Routineversorgung als Standard etabliert hat.

Methode

Daten der multizentrischen Beobachtungsstudie „Qualitätssicherung Kolon-Karzinom (Primärtumor)“ aus dem Zeitraum 01.01.2009 bis 31.12.2011 wurden hinsichtlich der Frage nach dem Anteil laparoskopischer Kolonkarzinomresektionen insgesamt, bezogen auf die Tumorlokalisation sowie spezifisch in Bezug auf die laparoskopische Sigmakarzinomresektion ausgewertet. Es erfolgte ein Vergleich zwischen Low- und High-volume-Kliniken (< 30 vs. ≥ 30 Kolonkarzinomresektionen/Jahr).

Ergebnisse

Laparoskopische Kolonkarzinomresektionen erfolgten in 12,0 % vs. 21,4 % der Low- vs. High-volume-Kliniken (p < 0,001) mit signifikanter Zunahme in den Low-volume- (von 8,0 % auf 15,6 %; p < 0,001) und konstantem Anteil in den High-volume-Kliniken (21,7–21,1 %; p = 0,905). 49,7 % vs. 47,6 % der laparoskopischen Resektionen erfolgten beim Sigmakarzinom (p = 0,584). Hier fanden sich Unterschiede zwischen den Low- und High-volume-Kliniken in der Konversionsrate (17,3 % vs. 6,6 %; p < 0,001), den Resektatlängen (Ø 23,6 vs. 36,0 cm; p < 0,001) und der Lymphknotenausbeute (Ø n = 15,7 vs. 18,2; p = 0,008). Hinsichtlich der postoperativen Morbidität und Letalität fanden sich keine Unterschiede zwischen den Klinikgruppen. Die postoperative Morbidität und Verweildauer waren nach laparoskopischer Sigmaresektion signifikant geringer als nach konventioneller Sigmaresektion.

Schlussfolgerung

In den teilnehmenden Kliniken ist der laparoskopische Zugangsweg für die Kolonkarzinomresektion nicht der Standardzugang. Den höchsten Anteil hat der laparoskopische Zugangsweg bei Sigmakarzinomresektionen. Die Unterschiede in der Konversionsrate, den Resektatlängen und der Anzahl untersuchter Lymphknoten zwischen Low- und High-volume-Kliniken sind kritisch zu sehen und müssen im Zusammenhang mit den onkologischen Langzeitergebnissen bewertet werden.

Abstract

Background

Prospective randomized studies and meta-analyses have shown that laparoscopic resection for colonic cancer is equivalent to open resection with respect to the oncological results and has short-term advantages in the early postoperative outcome. The aim of this study was to investigate whether laparoscopic colonic resection has become established as the standard in routine treatment.

Methods

Data from the multicenter observational study „Quality assurance colonic cancer (primary tumor)“ from the time period from 1 January 2009 to 21 December 2011 were evaluated with respect to the total proportion of laparoscopic colonic cancer resections and tumor localization and specifically for laparoscopic sigmoid colon cancer resections. A comparison between low and high volume clinics (< 30 versus ≥ 30 colonic cancer resections/year) was carried out.

Results

Laparoscopic colonic cancer resections were carried out in 12 % versus 21.4 % of low and high volume clinics, respectively (p < 0.001) with a significant increase for low volume clinics (from 8.0 % to 15.6 %, p < 0.001) and a constant proportion in high volume clinics (from 21.7 % to 21.1 %, p = 0.905). For sigmoid colon cancer laparoscopic resection was carried out in 49.7 % versus 47.6 % (p = 0.584). Differences were found between low volume and high volume clinics in the conversion rates (17.3 % versus 6.6 %, p < 0.001), the length of the resected portion (Ø 23.6 cm versus 36.0 cm, p < 0.001) and the lymph node yield (Ø n = 15.7 versus 18.2, p = 0.008). There were no differences between the two groups of clinics regarding postoperative morbidity and mortality. The postoperative morbidity and length of stay were significantly lower for laparoscopic sigmoid resection than for conventional sigmoid resection.

Conclusion

The laparoscopic access route for colonic cancer resection is not the standard approach in the participating clinics. The laparoscopic access route has the highest proportion for sigmoid colon resection. The differences in the conversion rates, length of the resected portion and the number of lymph nodes investigated between the low volume and high volume clinics must be viewed critically and must be interpreted in connection with the long-term oncological results.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. H. Ptok, I. Gastinger, C. Bruns und H. Lippert geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. An-Institut für Qualitätssicherung in der operativen Medizin gGmbH, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, ZENIT II – Gebäude, 39120, Magdeburg, Deutschland

    H. Ptok, I. Gastinger & H. Lippert

  2. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland

    H. Ptok & C. Bruns

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  1. H. Ptok
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Correspondence to H. Ptok.

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Ptok, H., Gastinger, I., Bruns, C. et al. Versorgungsrealität in der laparoskopischen Chirurgie des Kolonkarzinoms in Deutschland. Chirurg 85, 583–592 (2014). https://doi.org/10.1007/s00104-014-2744-8

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