MRC CLASICC trial – Authors' reply

Guillou, Pierre J.; Quirke, Philip; Jayne, David; Thorpe, Helen

doi:10.1016/s0140-6736(05)67171-1

Cited by 55 publications

(87 citation statements)

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“…The limitations of laparoscopy were evident from the 16% rectal cancer circumferential resection margin (CRM) positivity rate reported in the MRC CLASICC trial. 4 The authors of the trial also reported a high conversion rate to open surgery of 34% in patients with rectal cancer, with an increase in postoperative morbidity and mortality in these patients. With further developments in laparoscopy, the subsequent COLOR II and COREAN trials saw the participation of surgeons with greater operative experience.…”

Section: Use Of the XI In Tmementioning

confidence: 96%

“…2 Since then, numerous authors have compared the outcomes of laparoscopic versus open colorectal surgery, with the more recent articles citing superior short-term outcomes and comparable oncological results. [3][4][5][6] However, the adoption of laparoscopic colorectal surgery remained slow due to the technical complexity of such procedures. 7 Data from the American Board of Colon and Rectal Surgery (ABCRS) showed that 3.6% of major colorectal operations were performed laparoscopically in 1994, and the increase was only up to 24.3% by 2005.…”

Section: Introductionmentioning

confidence: 99%

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The da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery

Ngu¹,

Tsang²,

Koh³

2017

RSRR

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Abstract:The Xi is the latest da Vinci surgical system approved for use in colorectal surgery. With its novel overhead architecture, slimmer boom-mounted arms, extended instrument reach, guided targeting, and integrated auxiliary technology, the Xi manages to address several limitations of earlier models. The versatility of this new system allows it to be implemented in a wide range of colorectal procedures -from complex multiquadrant colectomies to challenging mesorectal dissections in the pelvis. While commonly criticized for its cost and prolonged operative time, robotic colorectal surgery holds the potential for enhanced ergonomics, superior precision, and a reduction in the learning curve involved in training an expert surgeon. This review appraises the existing literature on robotic colorectal surgery while elaborating how the improved capabilities of the Xi serve to usher in a new era of minimally invasive colorectal surgery.

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Section: Use Of the XI In Tmementioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

The da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery

Ngu¹,

Tsang²,

Koh³

2017

RSRR

View full text Add to dashboard Cite

show abstract

“…In the MRC CLA-SICC (Conventional vs. Laparoscopic-Assisted Surgery in Colorectal Cancer) trial, rectal cancer patients have been included into a randomized trial for the first time. [12] A 29% conversion rate has been reported. In patients with conversion, complication rates have been slightly higher.…”

Section: Discussionmentioning

confidence: 99%

The comparison of laparoscopic and conventional surgery for colorectal cancers: Evaluation of the initial experience

Çetinkünar¹

2017

Laparosc Endosc Surg Sci

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“…19,142,143 Laparoscopic colorectal surgery has gained widespread application worldwide, due to the impressive number of statistically robust studies that have been published, including many RCTs [144][145][146][147][148] with long follow-up [149][150][151][152][153] and meta-analyses. [154][155][156] Other reasons for the larger penetration of laparoscopic colorectal surgery, compared to upper gastrointestinal and hepatopancreatic surgery, is represented by the high incidence of colorectal cancer, which permits adequate case-load with acceptable technical challenge in most of the hospitals worldwide.…”

Section: Colon and Rectummentioning

confidence: 99%

“…This is because the famous CLASSIC trial 147 reported inferior results without oncologic safety and a Cochrane review 157 did not assess the safety of the procedure compared to open surgery. The narrow experience of many of the surgeons participating in the initial trials could also have played a role in justifying the poor results.…”

Section: Colon and Rectummentioning

confidence: 99%

Gastrointestinal robotic surgery: challenges and developments

Becchini¹,

Annecchiarico²,

Marino³

et al. 2015

RSRR

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Abstract:The rapid diffusion of new technologies in surgery, together with high expectations of both patients and the mass media, has led to many gastrointestinal procedures being approached using robots. Robotic technology seems to resolve many of the drawbacks of laparoscopic advanced procedures, such as anastomotic reconstructions, accurate lymphadenectomy, and vascular sutures. In addition, a deeper tridimensional steady vision with excellent high definition, the EndoWrist technology offering seven degrees of freedom, tremor filtration, scaled motion, optimal working ergonomics, and avoidance of the 'fulcrum effect', are the main strengths of the da Vinci ® system. The use of near-infrared technology and the possibility of tutoring through a double-console will most likely add many more advantages of this technology over laparoscopy alone. However, none of the gastrointestinal robotic interventions has reached a level of evidence-based efficacy that enables it to be routinely applied. The main limitations of robotic gastrointestinal procedures are represented by the learning curve, the higher costs of robotic surgery compared to traditional and laparoscopic surgery, and the longer operation times, including setup and organizational troubles. Moreover, while the limits of robotics for benign diseases are mainly represented by technical issues, oncologic outcomes remain the foundation of any procedures to cure malignancies, and long-term follow-up is still lacking. On the other hand, a word of caution should be presented on the adoption of robotics in too many surgical units without the correct and formal technical background and third-party control to guarantee the best outcomes for patients at minimum risk. Therefore, the robotic treatment of gastrointestinal diseases requires a thorough analysis of the published evidence, in order to determine the correct indications and patient selection. This review aims to examine the evidence for the use of robotic surgery in both malignancies and benign disease arising from the gastrointestinal area. Future developments in robotics and ongoing areas of research are also analyzed.

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MRC CLASICC trial – Authors' reply

Cited by 55 publications

References 0 publications

The da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery

The da Vinci Xi: a review of its capabilities, versatility, and potential role in robotic colorectal surgery

The comparison of laparoscopic and conventional surgery for colorectal cancers: Evaluation of the initial experience

Gastrointestinal robotic surgery: challenges and developments

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