Long‐term follow‐up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Issue 1 (6th November 2012)

• Record Type: Journal Article
• Authors: Green, B. L.; Marshall, H. C.; Collinson, F.; Quirke, P.; Guillou, P.; Jayne, D. G.; Brown, J. M.
• Is Part Of: British journal of surgery. Volume 100:Issue 1(2013:Jan.)
• Page Start: 75
• Page End: 82
• Publication Date: 2012-11-06
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.8945
• Languages: English
• ISSNs: 0007-1323

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="abs1-1" sec-type="section"> <title>Background:</title> <p>Laparoscopic resection is used widely in the management of colorectal cancer; however, the data on long‐term outcomes, particularly those related to rectal cancer, are limited. The results of long‐term follow‐up of the UK Medical Research Council trial of laparoscopically assisted <italic>versus</italic> open surgery for colorectal cancer are presented.</p> </sec> <sec id="abs1-2" sec-type="section"> <title>Methods:</title> <p>A total of 794 patients from 27 UK centres were randomized to laparoscopic or open surgery in a 2:1 ratio between 1996 and 2002. Long‐term follow‐up data were analysed to determine differences in survival outcomes and recurrences for intention‐to‐treat and actual treatment groups.</p> </sec> <sec id="abs1-3" sec-type="section"> <title>Results:</title> <p>Median follow‐up of all patients was 62·9 (interquartile range 22·9 − 92·8) months. There were no statistically significant differences between open and laparoscopic groups in overall survival (78·3 (95 per cent confidence interval (c.i.) 65·8 to 106·6) <italic>versus</italic> 82·7 (69·1 to 94·8) months respectively; <italic>P</italic> = 0·780) and disease‐free survival (DFS) (89·5 (67·1 to 121·7) <italic>versus</italic> 77·0 (63·3 to 94·0) months; <italic>P</italic> = 0·589). In colonic cancer intraoperative conversions to open surgery were associated with worse overall survival (hazard ratio (HR) 2·28, 95 per cent c.i. 1·47 to 3·53; <italic>P</italic> < 0·001) and DFS (HR 2·20, 1·31 to 3·67; <italic>P</italic> = 0·007). In terms of recurrence, no significant differences were observed by randomized procedure. However, at 10 years, right colonic cancers showed an increased propensity for local recurrence compared with left colonic cancers: 14·7 <italic>versus</italic> 5·2 per cent (difference 9·5 (95 per cent c.i. 2·3 to 16·6) per cent; <italic>P</italic> = 0·019).</p> </sec> <sec id="abs1-4" sec-type="section"> <title>Conclusion:</title> <p>Long‐term results continue to support the use of laparoscopic surgery for both colonic and rectal cancer. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.</p> </sec> </abstract>