Laparoscopic surgery for colorectal cancer
- Evidence is that oncologically, it is no worse than open, though less clear for anterior resections.
- Initial concerns about port-site recurrence not observed in other studies.
- Learning curve.
- More expensive.
- Longer surgery.
- Less morbidity (less pain, earlier recovery, less bowel ileus, etc.).
Several randomised control trials. Concerns that many studies collected data on surgeons still early in their learning curve.
- COST 
- MRC CLASICC Trial 
- COLOR 
- Concerns over oncological clearence margin particulary in low rectal tumours. Evidence reviewed in 
- Cochrance review overall in favour. 
- The NICE 2000 Guidance was produced prior to publication of most of the randomised controlled trials. As such, it concluded that all surgery should take place only in the context of a randomised controlled trial. This has been reviewed in 2006 and the current stance is that the long-term outcomes between open and laparoscopic approaches are similar with benefits in the shorter term for laparoscopic surgery. NICE do acknowledge that the UK has a relative dearth of expertise in laparoscopic colorectal surgery and have put a caveat that such surgery should be performed by adequately trained surgeons.
- ↑ Phillips EH, Franklin M, Carroll BJ, Fallas MJ, Ramos R, Rosenthal D. Laparoscopic colectomy. Annals of surgery. 1992 Dec; 216(6):703-7.
- ↑ Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004 May 13;350(20):2050-9.
- ↑ Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM; MRC CLASICC trial group. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005 May 14-20;365(9472):1718-26.
- ↑ Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM; COlon cancer Laparoscopic or Open Resection Study Group (COLOR). Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005 Jul;6(7):477-84.
- ↑ Aziz O, Constantinides V, Tekkis PP, Athanasiou T, Purkayastha S, Paraskeva P, Darzi AW, Heriot AG. Laparoscopic Versus Open Surgery for Rectal Cancer: A Meta-Analysis. Ann Surg Oncol. 2006 Mar;13(3):413-424.
- ↑ Cochrane Review
- ↑ NICE Guidance 2000 (pdf); Web-site: NICE Guidance 2000
- ↑ NICE Guidelines 2006. (Direct link - pdf).