Long-term follow-up of the Medical Research Council CLASICC trial of conventionalversuslaparoscopically assisted resection in colorectal cancer

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Abstract

Background:

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 assistedversusopen surgery for colorectal cancer are presented.

Methods:

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.

Results:

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)versus82·7 (69·1 to 94·8) months respectively;P= 0·780) and disease-free survival (DFS) (89·5 (67·1 to 121·7)versus77·0 (63·3 to 94·0) months;P= 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;P< 0·001) and DFS (HR 2·20, 1·31 to 3·67;P= 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: 14·7versus5·2 per cent (difference 9·5 (95 per cent c.i. 2·3 to 16·6) per cent;P= 0·019).

Conclusion:

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.

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