gms | German Medical Science

Objective: Overall survival (OS) of the most common tumors has significantly increased mainly because of the improved therapeutic armamentarium. Closer follow-up including more frequent and better imaging leads to a growing detection of metastases. In symptomatic metastases neurosurgical therapy might help to improve the quality of life and leads to longer OS. Among neurosurgical centers metastasis therapy nowadays plays a more important role than a decade ago. This study should estimate the neurosurgical capacity needed for metastases treatment in 2030.

Methods: Details of neurosurgical operations carried out for metastases were analyzed over the years (OPS codes 5-015.1 and 5-035.0-7; ICD 10 codes C79.3 and C79.5). Surgical records, histology, duration (start of anesthetic procedure to leaving the OR), surgical technique, length of hospital stay and growth rates regarding total operation numbers were analyzed. Revision surgery or VP-shunt placement in metastatic patients were not included. A calculation of the estimated case load in the year 2030 was carried out analyzing the changes of OS rates of the underlying metastatic disease and assuming a linear increase in the next decade. By this we try to estimate the capacity needed to treat metastatic disease in neurosurgery in 2030.

Results: Neurosurgery faced an increase of metastases surgery during the last 14 years. The number of surgeries for spinal metastases increased from 11/year (y) to 53/y representing a growth factor of 3.81 (intracranial metastases: 22/y to 71/y, growth factor 2.81). Time consumption for metastases surgery in 2017 was 31.529 minutes representing 11% of the annual total neurosurgical capacity. Between the year 2000 and 2018, overall survival rates for the 4 main cancer diagnoses seen in our collective improved by a mean growth factor of 3.19, representing an annual increase of 0.17. Assuming a linear increase of overall survival in the next years a growth factor of 2.12 has to be taken into account for estimating the changes for the year 2030. The expected neurosurgical capacity assumed can be calculated with 23.4% for only metastases surgery in 2030.

Conclusion: Metastases treatment will play an intensified role in the neurosurgical field of the year 2030. Our analysis most probably undervalues the real work load being needed in 2030 since our calculation underestimates the surgical capacity, length of hospital stay or time needed for interdisciplinary management of the cases.