title: The care of patients with colon cancer: current treatment, and evaluation of new surgical approaches.
abstract: BACKGROUND
  Multi-center observational studies in surgery can yield important findings, as long as they are appropriately designed and monitored and employ modern methods of statistical analysis.
  
  
  METHODS
  In a multi-center quality assurance study carried out in 346 German hospitals from 2000 to 2004, data were collected from a total of 31 055 patients who underwent surgery for colon carcinoma. The current, overall state of medical care for this disease was analyzed, with particular attention to aspects of quality assurance.
  
  
  RESULTS
  46.7% of the patients were in the advanced, prognostically unfavorable stages UICC III and IV and had an overall 5-year survival of 53.8% in stage III and 9.8% in stage IV. Laparoscopic intention-to-treat procedures were performed on 1401 patients (4.7%), of whom 20.6% required conversion to laparotomy. The patients who required conversion to laparotomy had a worse overall outcome. 28 271 patients were treated with tumor resection and primary anastomosis; in this group, 3% (n = 844) developed an anastomotic leak. Logistic regression analysis identified the following risk factors for anastomotic leakage: duration of surgery, ileus, tumor localization in the left colon, and single-layer suturing.
  
  
  CONCLUSIONS
  This multi-center observational study yields valid findings about the epidemiology and overall quality of medical care for colon carcinoma in Germany.
authors.affiliation: An-Institut für Qualitätssicherung in der operativen Medizin, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Kube
authors.forename: Ingo
authors.initials: I
authors.lastname: Gastinger
authors.forename: Pawel
authors.initials: P
authors.lastname: Mroczkowski
authors.forename: Henry
authors.initials: H
authors.lastname: Ptok
authors.forename: Steffanie
authors.initials: S
authors.lastname: Wolff
authors.forename: Hans
authors.initials: H
authors.lastname: Lippert
mesh_terms: D003110:Colonic Neoplasms / Q000401:mortality* / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000401:mortality*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D011183:Postoperative Complications / Q000401:mortality*; D015995:Prevalence; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome