Laparoscopic <i>versus</i> open colorectal surgery in the acute setting (LaCeS trial): a multicentre randomized feasibility trial

Harji, Deena; Marshall, Hannah; Gordon, Kathryn; Twiddy, Maureen; Pullan, Alison; Meads, David; Croft, Julie; Burke, Dermot; Griffiths, Ben; Verjee, Azmina; Sagar, P. M.; Stocken, Deborah

doi:10.1002/bjs.11703

Cited by 17 publications

(26 citation statements)

References 34 publications

(37 reference statements)

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“…The recent LaCeS trial has demonstrated that randomization of a cohort of ES patients between laparoscopic and an open surgical approach is feasible, acceptable and safe, albeit with a conversion rate of 39% [ 271 ]. Vallance et al [ 272 ] have examined patient and institutional factors associated with the laparoscopic approach for urgent surgery for colorectal cancer in the English National Bowel Cancer Audit.…”

Section: Colorectal Cancermentioning

confidence: 99%

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

et al. 2021

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Aim There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence‐based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. Methods Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology‐based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence‐based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. Results All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. Conclusion These guidelines provide an up to date and evidence‐based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.

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Section: Colorectal Cancermentioning

confidence: 99%

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

et al. 2021

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“…However, if the evidence supports subspecialists having superior outcomes to their counterparts then an alternative model may be required. Following the recent LaCeS trial, which showed an acceptable safety profile for emergency laparoscopic colorectal surgery, we are likely to see further studies assessing this and an increasing use of laparoscopic surgery in the emergency setting [42]. To enable this, we must ensure there is an appropriately structured workforce and trained specialist care available.…”

Section: Discussionmentioning

confidence: 99%

“…showed an acceptable safety profile for emergency laparoscopic colorectal surgery, we are likely to see further studies assessing this and an increasing use of laparoscopic surgery in the emergency setting [42]. To enable this, we must ensure there is an appropriately structured workforce and trained specialist care available.…”

Section: Predictors Of 30-day Postoperative Mortality In Patients Undmentioning

confidence: 99%

The impact of surgical subspecialization on patient outcomes following emergency colorectal resections in the north of England: a retrospective cohort study

et al. 2020

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Aim Emergency colorectal surgery is associated with significant morbidity and mortality. Most general surgeons have a subspecialty, which forms the focus of their elective work, allowing development of specialist skill sets. The aim of this study was to assess the impact of consultant subspecialization on patient outcomes following emergency colorectal resections. Methods Data were requested for all emergency admissions under a general surgeon between 1 January 2002 and 31 December 2016 within the north of England. These were acquired from individual Trusts following Caldicott approval. Data included demographics, diagnoses and any procedures undertaken. Patients were assigned to cohorts based on the subspecialist interest of the consultant they were under the care of. The primary outcome of interest was 30‐day postoperative mortality. Categorical data were compared with the chi‐squared test, and continuous data with the t test or ANOVA. A logistic regression model determined factors associated with 30‐day in‐hospital mortality. Results Overall, 7648 emergency colorectal resections were performed with a 30‐day postoperative mortality of 13.8%. This was significantly lower if the responsible consultant was a colorectal surgeon compared with other general surgery subspecialties (11.8% vs. 15.2%, P < 0.001). This was significant on univariate analysis (OR 0.75, P < 0.001); however, following multivariable adjustment, this was not statistically significant (P = 0.380). The colorectal specialists had a higher laparoscopy rate than their colleagues—9.8% versus 6.8% (P < 0.001). Stoma rates were also lower (46.9% vs. 51.0%, P = 0.001) and anastomosis rates higher (55.9% vs. 49.3%, P < 0.001) amongst colorectal surgeons. Conclusion These findings add to the growing body of evidence that patient outcomes may be improved by involving subspecialists in colorectal emergencies.

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“…The 'Laparoscopic versus open colorectal surgery in the acute setting' (LaCeS) multicentre randomized feasibility trial 12 recruited from five UK NHS Trusts and randomized patients presenting with acute colorectal pathology requiring resection, to receive laparoscopic or open surgery. The trial was registered with registration number: ISRCTN15681041 (http://www.controlled-trials.com).…”

Section: Methodsmentioning

confidence: 99%

Recruiting to surgical trials in the emergency setting: using a mixed methods study to understand clinician and patient perspectives

et al. 2022

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Background Undertaking randomized clinical trials (RCTs) in emergency surgical settings is associated with methodological and practical challenges. This study explored patients’ and clinicians’ perspectives associated with the conduct of an RCT comparing laparoscopic and open colorectal surgery in the acute setting. Methods All eligible patients screened and enrolled for the ‘Laparoscopic versus open colorectal surgery in the acute setting (LaCeS)’ multicentre, randomized clinical feasibility trial in five UK NHS Trusts were invited to respond to a survey. Patients and healthcare professionals were also invited to take part in semi-structured interviews. Survey and interviews explored the acceptability of the feasibility trial. Interviews were audio recorded, transcribed verbatim, and analysed using thematic analysis. Survey data were analysed descriptively to assess patient views of the trial and intervention. Results Out of 72 patients enrolled for the LaCeS RCT, survey data were collected from 28 patients (38.9 per cent), and interviews were conducted with 16 patients and 14 healthcare professionals. Thirteen out of 28 patients (46 per cent) had treatment preferences but these were not strong enough to deter participation. Twelve of the patients interviewed believed that their surgeon preferred laparoscopic surgery, but this did not deter them from participating in the trial. Half of the surgeons interviewed expressed the view that laparoscopic surgery was of benefit in this setting, but recognized that the need for research evidence outweighed their personal treatment preferences. Eight of the 14 recruiters reported that the emergency setting affected recruitment, especially in centres with fewer recruiting surgeons. Interviewees reported that recruitment was helped significantly by using surgical trainees to consent patients. Conclusion This study identified specific challenges for the LaCeS trial design to address and adds significant insights to our understanding of recruiting to emergency surgical trials more broadly.

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Laparoscopic versus open colorectal surgery in the acute setting (LaCeS trial): a multicentre randomized feasibility trial

Cited by 17 publications

References 34 publications

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

The impact of surgical subspecialization on patient outcomes following emergency colorectal resections in the north of England: a retrospective cohort study

Recruiting to surgical trials in the emergency setting: using a mixed methods study to understand clinician and patient perspectives

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