Minimally Invasive Colorectal Cancer Surgery in Europe: Implementation and Outcomes.
Minimally invasive surgery (MIS) of colorectal cancer (CRC) was first introduced over 20 years ago and recently has gained increasing acceptance and usage beyond clinical trials. However, data on dissemination of the method across countries and on long-term outcomes are still sparse.In the context of a European collaborative study, a total of 112,023 CRC cases from 3 population-based (N = 109,695) and 4 institute-based clinical cancer registries (N = 2328) were studied and compared on the utilization of MIS versus open surgery. Cox regression models were applied to study associations between surgery type and survival of patients from the population-based registries. The study considered adjustment for potential confounders.The percentage of CRC patients undergoing MIS differed substantially between centers and generally increased over time. MIS was significantly less often used in stage II to IV colon cancer compared with stage I in most centers. MIS tended to be less often used in older (70+) than in younger colon cancer patients. MIS tended to be more often used in women than in men with rectal cancer. MIS was associated with significantly reduced mortality among colon cancer patients in the Netherlands (hazard ratio [HR] 0.66, 95% confidence interval [CI] (0.63-0.69), Sweden (HR 0.68, 95% CI 0.60-0.76), and Norway (HR 0.73, 95% CI 0.67-0.79). Likewise, MIS was associated with reduced mortality of rectal cancer patients in the Netherlands (HR 0.74, 95% CI 0.68-0.80) and Sweden (HR 0.77, 95% CI 0.66-0.90).Utilization of MIS in CRC resection is increasing, but large variation between European countries and clinical centers prevails. Our results support association of MIS with substantially enhanced survival among colon cancer patients. Further studies controlling for selection bias and residual confounding are needed to establish role of MIS in survival of patients.
From the Division of Clinical Epidemiology and Aging Research (MB, LJ, AG, HB), German Cancer Research Center (DKFZ); Division of Preventive Oncology (YB, CMU, PS-K, HB), German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; Comprehensive Cancer Organization (VL), Utrecht, the Netherlands; Department of Molecular Medicine and Surgery (AS), Karolinska Institutet, Center for Digestive Diseases, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden; Norwegian Cancer Registry (TBJ), Oslo, Norway; Datacenter (MM); Department of Surgical Oncology (LG), Institute Jules Bordet (IJB), Bruxelles, Belgium; Portuguese Oncology Institute of Porto (IPO-Porto) (AFG, MJB), Porto, Portugal; Biometrics Department (TvdV), The Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands; Clinical Cancer Registry (LRK, NB), National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ) ; Department of surgery of Heidelberg University Hospital (AU), Heidelberg, Germany; Huntsman Cancer Institute (CMU), Salt Lake City, UT; and German Cancer Consortium (DKTK) (HB), German Cancer Research Center (DKFZ), Heidelberg, Germany.
Masoud
M
Babaei
Yesilda
Y
Balavarca
Lina
L
Jansen
Adam
A
Gondos
Valery
V
Lemmens
Annika
A
Sjövall
Tom
T
Brge Johannesen
Michel
M
Moreau
Liberale
L
Gabriel
Ana Filipa
AF
Gonçalves
Maria José
MJ
Bento
Tony
T
van de Velde
Lana Raffaela
LR
Kempfer
Nikolaus
N
Becker
Alexis
A
Ulrich
Cornelia M
CM
Ulrich
Petra
P
Schrotz-King
Hermann
H
Brenner
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000401:mortality / Q000601:surgery*; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D012042:Registries; D012737:Sex Factors; D016896:Treatment Outcome