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1.
Gesundheitswesen ; 2024 Apr 02.
Artigo em Alemão | MEDLINE | ID: mdl-38565190

RESUMO

OBJECTIVES: Breast cancer is the most common cancer and the most common cancer-related cause of death among women in Germany. The treatment in certified breast cancer centre networks is recommended to ensure high-quality care. The aim of the study was to determine the percentage of breast cancer patients receiving cancer treatment in certified breast cancer centre networks in Upper Franconia, Germany. METHODS: This study considered the location of treatment and the certification status of providers with regard to initial diagnosis, surgery, chemotherapy, and radiation during breast cancer care. Based on this, we compared patient characteristics receiving cancer care in certified and non-certified cancer centres and their networks. The evaluation was based on a dataset of the Bavarian Cancer Registry (4/2017-3/2022). RESULTS: The analysis included 5,545 primary tumors from a total of 5,355 patients (age: 64.5±14.2 years; 99.2% female). The percentage of patients receiving care in certified breast cancer centre networks was 78.8% for initial diagnosis, 82.6% for surgery, 79.5% for chemotherapy, and 99.6% for radiation, respectively. The weighted mean across all treatment sequences was 84.3%. Patients receiving care in certified care networks were significantly younger for three therapy sequences (p+<+0.001). In addition, an above-average proportion of patients with advanced tumor stages were treated in non-certified care networks, especially for diagnosis and surgery (p+<+0.001). CONCLUSIONS: Regarding the different treatment sequences, we found differences in the proportion of patients who received quality-assured treatment in certified breast cancer centre networks in Upper Franconia. When comparing similar analysis, the results show an average care percentage of patients receiving care in certified care networks. Furthermore, it should be ensured that patients receive comprehensive information about receiving care in certified cancer centre networks.

2.
BMC Cancer ; 23(1): 149, 2023 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-36782134

RESUMO

BACKGROUND: As a consequence of effective treatment procedures, the number of long-term survivors of colorectal cancer is ever increasing. Adopting the method of a previous study on breast cancer patients, the goal of the present research was to investigate colorectal cancer patients' recollections of their illness and treatment experiences up to seven years after they have been enrolled in a randomised controlled clinical trial on the direct improvement of quality of life (RCT DIQOL). METHODS: Colorectal cancer survivors in Bavaria, Germany were mailed a questionnaire on average 78·3 months after the start of their therapy and enrolment into RCT DIQOL. The questionnaire enquired about their worst experience during the colorectal cancer episode, positive aspects of the illness, and any advice they would give to newly diagnosed patients. Patient responses were categorised by two independent raters and cross-checked by a third independent rater. Frequencies of these categories were then quantitatively analysed using descriptive statistics. RESULTS: Of 146 remaining survivors initially enrolled in RCT DIQOL, 96 (66%) returned the questionnaire. The majority (33%) of statements regarding the worst experience was referring to "psychological distress", followed by "indigestion and discomfort during defecation" (17%), and "cancer diagnosis" (16%). Among survivors with history of a stoma, the majority (36%) regarded "stoma" as their worst experience. With 45%, "change in life priorities" has been the most frequent positive category before "support by physicians/ nurses" (25%). 43% of the survivors deemed "fighting spirit" as most important advice to overcome the disease. CONCLUSION: Even after many years, colorectal cancer survivors clearly remember experiences from the time of their illness. Echoing the results of the previous breast cancer survivors' study, "psychological distress", "change in life priorities" and "fighting spirit" emerged as prominent concepts. In addition, some aspects like the impact of a stoma are of specific importance for colorectal cancer survivors. These findings can be used to inform programmes to improve patient- and quality of life centred aftercare of tumour patients. CLINICAL TRIAL INFORMATION: NCT04930016, date of registration 18.06.2021.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Neoplasias Colorretais , Humanos , Feminino , Sobreviventes de Câncer/psicologia , Qualidade de Vida/psicologia , Neoplasias Colorretais/patologia , Sobreviventes/psicologia , Neoplasias da Mama/terapia , Neoplasias da Mama/psicologia
3.
Surg Endosc ; 36(2): 1172-1180, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-33650009

RESUMO

BACKGROUND: Since 2010, laparoscopic transanal total mesorectal excision (TaTME) has been increasingly used for low and very low rectal cancer. It is supposed to improve visibility and access to the dissection planes in the pelvis. This study reports on short- and long-term outcomes of the first 100 consecutive patients treated with TaTME in a certified German colorectal cancer center. PATIENTS AND METHODS: Data were derived from digital patient files and official cancer registry reports for patients with TaTME tumor surgery between July 2014 and January 2020. The primary outcome was the 3-year local recurrence rate and local recurrence-free survival (LRFS). Secondary endpoints included overall survival (OAS), disease-free survival (DFS), operation time, completeness of local tumor resection, lymph node resection, and postoperative complications. The Kaplan-Meier method was employed for the survival analyses; competing risks were considered in the time-to-event analysis. RESULTS: During the observation period, the average annual operation time decreased from 272 to 178 min. Complete local tumor resection was achieved in 97% of the procedures. Major postoperative complications (Clavien-Dindo 3-4) occurred in 11% of the cases. At a median follow-up time of 2.7 years, three patients had suffered from a local recurrence. Considering competing risks, this corresponds to a 3-year cumulative incidence rate for local recurrence of 2.2% and a 3-year LRFS of 81.9%. 3-year OAS was 82.9%, and 3-year DFS was 75.7%. CONCLUSION: TaTME is associated with favorable short and long-term outcomes. Since it is technically demanding, structured training programs and more research on the topic are indispensable.


Assuntos
Laparoscopia , Protectomia , Neoplasias Retais , Cirurgia Endoscópica Transanal , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Protectomia/efeitos adversos , Reto/cirurgia , Cirurgia Endoscópica Transanal/métodos , Resultado do Tratamento
4.
Breast Cancer Res Treat ; 189(3): 817-826, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34338943

RESUMO

PURPOSE: To extend the functionality of the existing INFLUENCE nomogram for locoregional recurrence (LRR) of breast cancer toward the prediction of secondary primary tumors (SP) and distant metastases (DM) using updated follow-up data and the best suitable statistical approaches. METHODS: Data on women diagnosed with non-metastatic invasive breast cancer were derived from the Netherlands Cancer Registry (n = 13,494). To provide flexible time-dependent individual risk predictions for LRR, SP, and DM, three statistical approaches were assessed; a Cox proportional hazard approach (COX), a parametric spline approach (PAR), and a random survival forest (RSF). These approaches were evaluated on their discrimination using the Area Under the Curve (AUC) statistic and on calibration using the Integrated Calibration Index (ICI). To correct for optimism, the performance measures were assessed by drawing 200 bootstrap samples. RESULTS: Age, tumor grade, pT, pN, multifocality, type of surgery, hormonal receptor status, HER2-status, and adjuvant therapy were included as predictors. While all three approaches showed adequate calibration, the RSF approach offers the best optimism-corrected 5-year AUC for LRR (0.75, 95%CI: 0.74-0.76) and SP (0.67, 95%CI: 0.65-0.68). For the prediction of DM, all three approaches showed equivalent discrimination (5-year AUC: 0.77-0.78), while COX seems to have an advantage concerning calibration (ICI < 0.01). Finally, an online calculator of INFLUENCE 2.0 was created. CONCLUSIONS: INFLUENCE 2.0 is a flexible model to predict time-dependent individual risks of LRR, SP and DM at a 5-year scale; it can support clinical decision-making regarding personalized follow-up strategies for curatively treated non-metastatic breast cancer patients.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/terapia , Terapia Combinada , Feminino , Humanos , Recidiva Local de Neoplasia/epidemiologia , Países Baixos/epidemiologia , Nomogramas
5.
Surg Endosc ; 34(3): 1142, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31538228

RESUMO

The article, "Laparoscopic and open surgery in rectal cancer patients in Germany: short and long­term results of a large 10-year population-based cohort," written by Valentin Schnitzbauer, Michael Gerken, Stefan Benz, Vinzenz Völkel,, Teresa Draeger, Alois Fürst, and Monika Klinkhammer-Schalke was originally published electronically on the publisher's internet portal (currently SpringerLink) on 30 May 2019 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on September 18, 2019 to © The Author(s) [Year] and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit original author(s) and the source, provide a link to the Creative Commons licence and indicate if changes were made.

6.
Surg Endosc ; 34(3): 1132-1141, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31147825

RESUMO

BACKGROUND: Rectal cancer is frequent in Germany and worldwide. Several studies have assessed laparoscopic surgery as a treatment option and most have shown favorable results. However, long-term oncologic safety remains a controversial issue. METHODS: The current dataset derives from 30 clinical cancer registries in Germany and includes 16,378 patients diagnosed with rectal cancer between 2007 and 2016. Outcomes were 90-day mortality, overall survival (OS), local recurrence-free survival (RFS) and relative survival of patients treated with either open or laparoscopic surgery. Multivariable logistic regression was used to evaluate factors that affected the probability of a patient undergoing laparoscopic surgery as well as to evaluate short-term mortality. OS and RFS were analyzed by Kaplan-Meier plots and multivariable Cox regression conducted separately for UICC stages I-III, tumor location, and sex as well as by propensity score matching followed by univariable and multivariable survival analysis. RESULTS: Of 16,378 patients, 4540 (27.7%) underwent laparoscopic surgery, a trend which increased during the observation period. Patients undergoing laparoscopy attained better results for 90-day mortality (odds ratio, OR 0.658, 95% confidence interval, CI 0.526-0.822). The 5-year OS rate in the laparoscopic group was 82.6%, vs. 76.6% in the open surgery group, with a hazard ratio (HR) of 0.819 in multivariable Cox regression (95% CI 0.747-0.899, p < 0.001). The laparoscopic group showed a better 5-year RFS, with 81.8 vs. 74.3% and HR 0.770 (95% CI 0.705-0.842, p < 0.001). The 5-year relative survival rates were also in favor of laparoscopy, with 93.1 vs. 88.4% (p = 0.012). CONCLUSION: Laparoscopic surgery for rectal cancer can be performed safely and, according to this study, is associated with an oncological outcome superior to that of the open procedure. Therefore, in the absence of individual contraindications, it should be considered as a standard approach.


Assuntos
Laparoscopia , Protectomia/métodos , Neoplasias Retais/cirurgia , Adulto , Idoso , Conjuntos de Dados como Assunto , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Neoplasias Retais/mortalidade , Reto/cirurgia , Análise de Regressão , Estudos Retrospectivos , Análise de Sobrevida , Taxa de Sobrevida , Resultado do Tratamento
7.
Int J Colorectal Dis ; 34(5): 821-828, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30778670

RESUMO

INTRODUCTION: Rectal cancer is a frequently diagnosed tumor worldwide. Various studies have shown the noninferiority or even slight superiority of laparoscopic resection. However, there is no clear recommendation on whether age should influence the choice of surgical approach. MATERIALS AND METHODS: This study compared outcomes of laparoscopic and open surgery in rectal cancer patients. Perioperative mortality and 5-year overall, relative, and recurrence-free survival rates were analyzed separately for three age groups. Data originate from 30 regional German cancer registries that cover approximately one quarter of the German population. All primary nonmetastatic rectal adenocarcinoma cases with surgery between 2005 and 2014 were eligible for inclusion. To compare survival rates, Kaplan-Meier analysis, a relative survival model, and multivariable Cox regression were used; a sensitivity analysis assessed bias by exclusion. RESULTS: Ten thousand seven hundred fifty-four patients were included in the analysis. The mean laparoscopy rate was 23.0% and increased over time. Analysis of 30-day postoperative mortality rates revealed advantages for laparoscopically treated patients, although the significance level was not reached in any age group. Regarding 5-year overall survival, laparoscopy generally seems to be the superior approach, whereas for recurrence-free survival, an age-dependent gradient in effect size was observed: with a hazard ratio (HR) of 0.703 for laparoscopy, patients under 60 years benefitted more from the minimally invasive approach than older patients (septuagenarians, HR 0.923). CONCLUSION: Laparoscopy shows similar results to the open approach in terms of postoperative survival in all age groups. Concerning long-term outcomes, younger patients benefitted most from the minimally invasive approach.


Assuntos
Laparoscopia , Neoplasias Retais/epidemiologia , Neoplasias Retais/cirurgia , Fatores Etários , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/mortalidade , Análise de Sobrevida , Fatores de Tempo
8.
Gesundheitswesen ; 81(10): 801-807, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-29672814

RESUMO

AIM OF THE STUDY: Hospitals specializing in the treatment of colorectal carcinoma with high quality standards can apply for certification as colorectal cancer centers. The aim of this study was to clarify if there is a substantial difference between certified and non-certified hospitals in terms of long-term survival of patients. METHODS: This is a population-based retrospective cohort study using the data of a clinical cancer registry (Tumorzentrum Regensburg) which covers a southern German region of approximately 1.1 million inhabitants. 4302 patients with colorectal carcinoma who underwent radically surgery between 2004 and 2013 were divided into 4 groups for comparing certified and non-certified centers as well as the situation before and after certification. 3-year overall survival is displayed using Kaplan-Meier analysis, multivariate cox regression and relative survival models. Sensitivity analysis for missing data was conducted. RESULTS: The estimated 3-year survival rates of patients treated at certified compared to non-certified centers were 71.6% and 63.6%, respectively. Even after adjusting for possible confounders, treatment at certified centers was associated with significant survival benefits for patients (HR=0.808, CI: 0.665-0.982). Comparison of colorectal cancer centers before and after certification showed almost identical 3-year survival rates. Cox regression analysis also showed no substantial difference between the two (HR=0.964, CI: 0.848-1.096). CONCLUSION: Patients with colorectal cancer treated in certified compared to non-certified centers show long-term survival benefits. Patients of certified colorectal cancer centers show long-term survival benefits compared to those treated at non-certified centers. Early and successful implementation of high quality standards could explain why survival rates before and after certification do not differ.


Assuntos
Certificação , Neoplasias Colorretais , Hospitais/normas , Idoso , Institutos de Câncer/normas , Institutos de Câncer/estatística & dados numéricos , Certificação/estatística & dados numéricos , Neoplasias Colorretais/mortalidade , Feminino , Alemanha/epidemiologia , Hospitais/estatística & dados numéricos , Humanos , Masculino , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Análise de Sobrevida
9.
Surg Endosc ; 32(10): 4138-4147, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29602999

RESUMO

BACKGROUND: Over 20 years after the introduction of laparoscopic surgery for colon cancer, many surgeons still prefer the open approach. Whereas randomized controlled trials (RCTs) have proven the oncologic safety of laparoscopy, long-term data depicting daily clinical routine are scarce. METHODS: This population-based cohort study compares 5-year overall, relative, and recurrence-free survival rates after laparoscopic and open colon carcinoma surgery. Data derive from an independent German cancer registry encompassing all tumor patients within a political district of 1.1 million inhabitants. The final analysis included 2669 patients with major elective resection of primary non-metastatic colonic adenocarcinoma between January 1, 2004 and December 31, 2013. Survival rates were compared using Kaplan-Meier analyses, relative survival models, and multivariate Cox regression. Sensitivity analysis quantified selection bias. RESULTS: The proportion of laparoscopic procedures increased from 9.7 to 25.8% in 2011 and dropped again to 15.8% at the end of observation period. Laparoscopy patients were younger, had a lower tumor stage, and were more likely to receive postoperative chemotherapy. Overall, relative, and recurrence-free survival was significantly superior or equivalent in Kaplan-Meier analysis (5-year overall survival rate open vs. laparoscopic: 69.0 vs. 80.2%, p < 0.001). The superiority of laparoscopy mostly remained stable after adjusting for confounders, although significance was only reached in T1-3 patients without lymph node metastases (overall survival: hazard ratio (HR) 0.654; 95% confidence interval (CI) 0.446-0.958; p = 0.029). CONCLUSION: Laparoscopy is a safe and promising alternative to the open approach in daily clinic practice. These favorable outcomes require future confirmation by high-quality studies outside the setting of RTCs.


Assuntos
Adenocarcinoma/cirurgia , Colectomia/métodos , Neoplasias do Colo/cirurgia , Laparoscopia , Adenocarcinoma/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/mortalidade , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Seguimentos , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
10.
Surg Endosc ; 32(10): 4096-4104, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29611044

RESUMO

BACKGROUND: An increasing number of rectal carcinoma resections in Germany and worldwide are performed laparoscopically. The recently published COLOR II trial demonstrated the oncologic safety of this surgical approach. It remains unclear whether these findings can be transferred to clinical practice. PATIENTS AND METHODS: This population-based retrospective cohort study aimed to evaluate 5-year overall, relative, disease-free, and local recurrence-free survival of rectal cancer patients treated by open surgery and laparoscopy. Data from a southern German region of 1.1 million inhabitants were collected by an official clinical cancer registry. All primary non-metastatic rectal adenocarcinoma cases with surgery between 2004 and 2013 were eligible for inclusion. To compare survival rates, Kaplan-Meier analyses, relative survival models, and multivariate Cox regression were applied; a sensitivity analysis assessed bias by exclusion. RESULTS: Finally, 1507 patients with a median follow-up time of 7.1 years were included. Of these patients, 28.4% underwent laparoscopic procedures, with an increasing rate over time. Patients with tumors of the upper or middle rectum, younger patients, and patients of specialized colorectal cancer centers were more likely to undergo laparoscopy. After 5 years, 80.4% of laparoscopy patients were still alive, compared to 68.6% in the open group (p < 0.001). Moreover, laparoscopy was associated with superior local recurrence-free survival rates. This advantage was also significant in multivariate analysis (HR 0.70, 95% CI 0.52-0.92). CONCLUSION: Laparoscopic rectal cancer surgery can be considered safe in daily clinical practice. This should be confirmed by future studies outside the setting of randomized trials.


Assuntos
Colectomia/métodos , Laparoscopia/métodos , Neoplasias Retais/cirurgia , Reto/cirurgia , Idoso , Intervalo Livre de Doença , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento
12.
Cancers (Basel) ; 15(13)2023 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-37444491

RESUMO

Colorectal cancer (CRC) is the third most common cancer worldwide. The main treatment options are laparoscopic (LS) and open surgery (OS), which might differ in their impact on the cellular immunity so indispensable for anti-infectious and antitumor defense. MEDLINE, Embase, Web of Science (SCI-EXPANDED), the Cochrane Library, Google Scholar, ClinicalTrials.gov, and ICTRP (WHO) were systematically searched for randomized controlled trials (RCTs) comparing cellular immunity in CRC patients of any stage between minimally invasive and open surgical resections. A random effects-weighted inverse variance meta-analysis was performed for cell counts of natural killer (NK) cells, white blood cells (WBCs), lymphocytes, CD4+ T cells, and the CD4+/CD8+ ratio. The RoB2 tool was used to assess the risk of bias. The meta-analysis was prospectively registered in PROSPERO (CRD42021264324). A total of 14 trials including 974 participants were assessed. The LS groups showed more favorable outcomes in eight trials, with lower inflammation and less immunosuppression as indicated by higher innate and adaptive cell counts, higher NK cell activity, and higher HLA-DR expression rates compared to OS, with only one study reporting lower WBCs after OS. The meta-analysis yielded significantly higher NK cell counts at postoperative day (POD)4 (weighted mean difference (WMD) 30.80 cells/µL [19.68; 41.92], p < 0.00001) and POD6-8 (WMD 45.08 cells/µL [35.95; 54.21], p < 0.00001). Although further research is required, LS is possibly associated with less suppression of cellular immunity and lower inflammation, indicating better preservation of cellular immunity.

13.
Cancers (Basel) ; 15(18)2023 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-37760537

RESUMO

(1) Background: The WiZen study is the largest study so far to analyze the effect of the certification of designated cancer centers on survival in Germany. This certification program is provided by the German Cancer Society (GCS) and represents one of the largest oncologic certification programs worldwide. Currently, about 50% of colorectal cancer patients in Germany are treated in certified centers. (2) Methods: All analyses are based on population-based clinical cancer registry data of 47.440 colorectal cancer (ICD-10-GM C18/C20) patients treated between 2009 and 2017. The primary outcome was 5-year overall survival (OAS) after treatment at certified cancer centers compared to treatment at other hospitals; the secondary endpoint was recurrence-free survival. Statistical methods included Kaplan-Meier analysis and multivariable Cox regression. (3) Results: Treatment at certified hospitals was associated with significant advantages concerning 5-year overall survival (HR 0.92, 95% CI 0.89, 0.96, adjusted for a broad range of confounders) for colon cancer patients. Concentrating on UICC stage I-III patients, for whom curative treatment is possible, the survival benefit was even larger (colon cancer: HR 0.89, 95% CI 0.84, 0.94; rectum cancer: HR 0.91, 95% CI 0.84, 0.97). (4) Conclusions: These results encourage future efforts for further implementation of the certification program. Patients with colorectal cancer should preferably be directed to certified centers.

14.
Eur J Surg Oncol ; 45(9): 1607-1612, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31092363

RESUMO

BACKGROUND: Minimally invasive removal of rectal tumors has proven to be a safe alternative to the open approach. Despite increased use of laparoscopy, its eligibility for older adults requires further exploration. This study compares perioperative mortality and 5-year overall, disease-free, and relative survival after laparoscopic and open surgery in rectal cancer patients aged ≥80 years. MATERIALS AND METHODS: Data derive from 30 German regional cancer registries and cover approximately one quarter of the entire German population. All primary nonmetastatic rectal adenocarcinoma cases with surgery between 2005 and 2014 were eligible for inclusion. To compare survival rates, Kaplan-Meier analysis, a relative survival model, and multivariable Cox regression were applied; a sensitivity analysis assessed bias by exclusion. RESULTS: 1532 patients were included, of whom 17.1% underwent laparoscopic procedures. 30 days after surgery, 2.7% of the laparoscopy patients had died compared to 7.0% in the open surgery group. The multivariable analysis confirmed that minimally invasive procedures are followed by a lower 30-day postoperative mortality risk (odds ratio, OR, 0.352; 95% confidence interval, CI, 0.161-0.771; p = 0.009). With a 5-year disease-free survival rate of 52.0 vs. 47.6% (p = 0.557), only an nonsignificant long-term advantage of the minimally invasive approach was observed. CONCLUSION: Given the results of this study, older rectal cancer patients are likely to benefit from the laparoscopic approach in the short term, and there are also no disadvantages in terms of long-term survival. Therefore, laparoscopy should be considered a standard procedure for older adults as well.


Assuntos
Laparoscopia/métodos , Neoplasias Retais/mortalidade , Neoplasias Retais/cirurgia , Idoso de 80 Anos ou mais , Feminino , Alemanha/epidemiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Gradação de Tumores , Estadiamento de Neoplasias , Neoplasias Retais/patologia , Sistema de Registros
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