Effects of First Time Minimum Volume Regulation on the Surgical Treatment of Lung Cancer in Germany

Objectives: In 2021, the German Federal Joint Committee (G-BA) introduced minimum volume regulations (MVRs) for the surgical treatment of lung cancer with the aim of improving quality of care through centralization. The present study aimed to evaluate the impact of this regulation on the development of lung cancer surgery in Germany. Methods: We performed a retrospective analysis based on the AOK (medical insurance) minimum volume transparency lists (2024-2026) and certification data from the German Cancer Society (DKG). Primary endpoint was the development of hospital locations according to MVRs. Secondary endpoints included the number of operations, the number of DKG-certified lung cancer centers (LCs), and the percentage of procedures performed in DKG-certified LCs. Results: Nationwide, the number of hospital locations fell by 19.6% between January 2022 and June 2025 following the implementation of the MVRs, while the number of anatomical lung resections increased by 11.3%. The proportion of procedures performed at hospital locations with ≥75 operations per year (≙MVRs) increased from 42.3% to 82.2%. The number of DKG-certified LCs went up by 24.2% (62 to 77), and the percentage of resections performed there went from 56.6% to 69%. Lastly, 17.8% of hospital sites still got a billing permission, even though they did not meet the MVRs. Conclusions: Implementation of the MVRs was associated with substantial structural centralization of lung cancer surgery in Germany, characterized by fewer hospital sites (-19.6%), increased surgical volumes (+11.3%), and a growing proportion of care delivered in DKG-certified LCs (+24.2%).