Randomized Trial of Laparoscopic-Assisted Resection of Colorectal Carcinoma: 3-Year Results of the UK MRC CLASICC Trial Group

Jayne, David; Guillou, Pierre J.; Thorpe, Helen; Quirke, Philip; Copeland, Joanne; Smith, Andrew B. T.; Heath, Richard M.; Brown, Julia

doi:10.1200/jco.2006.09.7758

Cited by 1,405 publications

(986 citation statements)

References 21 publications

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“…3 The robotic surgery is especially suited for dissection in pelvis which requires precise movements and fine tissue dissection near critical structures None of the patients in our study was CRM positive. A recent report from a multi-institutional study (CLASICC trial) comparing CRM results from laparoscopic colorectal cancer surgery vs open surgery showed a concern of higher positive rate in the laparoscopic arm [17,18]. One of the most important factors relating to adequacy of rectal excision is the mesorectal grade, which is related to oncological outcome [2].…”

Section: Discussionmentioning

confidence: 99%

“…Recent investigations of laparoscopic colorectal resection for the treatment of cancer have revealed superior short-term operative outcomes and noninferior oncologic outcomes compared with open surgery, the classic standard treatment [18,23,24]. Although laparoscopic colon surgery is very popular, there is little doubt that laparoscopic rectal surgery is technically very challenging and the learning curve for this procedure is longer and more demanding than for laparoscopic colectomy.…”

Section: Discussionmentioning

confidence: 99%

“…A steep learning curve explains the low penetration rate for laparoscopic rectal resection. The oncologic and short-term operative outcomes may be impaired with inexperienced hands [18,23]. The steep learning curve is of concern especially, where the quality of mesorectal excision influences long-term outcomes [18].…”

Section: Discussionmentioning

confidence: 99%

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Prospective Randomized Study Comparing Robotic-Assisted Surgery with Traditional Laparotomy for Rectal Cancer—Indian Study

Somashekhar

Ashwin²,

Rajashekhar

et al. 2013

Indian J Surg

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Rectal cancer is one of the common cancers in India. Surgical management is the mainstay of initial treatment for majority of patients. Minimally invasive surgery has gained acceptance for the surgical treatment of rectal cancer because, compared with laparotomy, it is associated with fewer complications, shorter hospitalization, and faster recovery. The aim of this study is to evaluate the safety, feasibility, technique, and outcomes (postoperative, oncological, and functional) of robotic-assisted rectal surgery in comparison with open surgery in the Indian population. A prospective randomized study was undertaken from August 2011 to December 2012. Fifty patients who presented with rectal carcinoma were randomized to either robotic arm (RA) or open arm (OA) group. Both groups were matched for clinical stage and operation type. Technique and feasibility of roboticassisted surgery in terms of operating time, estimated blood loss, margins status, total number of lymph nodes retrieved, hospital stay, conversion to open procedure, complications, and functional outcomes were analyzed. The mean operative time was significantly longer in the RA than in the OA group (310 vs 246 min, P <0.001) but was significantly reduced in the latter part of the robotic-assisted patients compared with the initial patients. The mean estimated blood loss was significantly less in the RA compared with the OA group (165.14 vs 406.04 ml, P <0.001). None of the patients had margin positivity. The mean distal resection margin was significantly longer in the RA than in the OA group (3.6 vs 2.4 cm, P < 0.001). A total of 100 % of patients in the RA group had complete mesorectal excision while two patients in the OA group had incomplete mesorectal excision. The average number of retrieved lymph nodes was adequate for accurate staging. The number of lymph nodes removed by robotic method is slightly higher than the open method (16.88 vs 15.20) but with no statistical significance. Conversion rate was nil. The mean hospital stay was significantly shorter in the RA group (7.52 vs 13.24 days, P <0.001). Postoperative and functional outcomes were comparable between the two groups. Roboticassisted surgery is an emerging technique in our country. Robotic-assisted rectal cancer surgery is safe with low conversion rates and acceptable morbidity and is oncologically feasible.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prospective Randomized Study Comparing Robotic-Assisted Surgery with Traditional Laparotomy for Rectal Cancer—Indian Study

Somashekhar

Ashwin²,

Rajashekhar

et al. 2013

Indian J Surg

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“…Third, the follow‐up duration was relatively short. Although we thought that LR would generally be identified within 3 years after surgery35, 36, 37 and some RCT were also designed to compare the OS, DFS, or LR at this time point,6, 38, 39 longer follow up is required to confirm these results. We plan to follow up this cohort until 5 years after surgery.…”

Section: Discussionmentioning

confidence: 99%

Local control of sphincter‐preserving procedures and abdominoperineal resection for locally advanced low rectal cancer: Propensity score matched analysis

Okamura

Hida

Yamaguchi

et al. 2017

Annals of Gastroent Surgery

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Sphincter‐preserving procedures (SPPs) for surgical treatment of low‐lying rectal tumors have advanced considerably. However, their oncological safety for locally advanced low rectal cancer compared with abdominoperineal resection (APR) is contentious. We retrospectively analyzed cohort data of 1500 consecutive patients who underwent elective resection for stage II‐III rectal cancer between 2010 and 2011. Patients with tumors 2‐5 cm from the anal verge and clinical stage T3‐4 were eligible. Primary outcome was 3‐year local recurrence rate, and confounding effects were minimized by propensity score matching. The study involved 794 patients (456 SPPs and 338 APR). Before matching, candidates for APR were more likely to have lower and advanced lesions, whereas SPPs were carried out more often following preoperative treatment, by laparoscopic approach, and at institutions with higher case volume. After matching, 398 patients (199 each for SPPs and APR) were included in the analysis sample. Postoperative morbidity was similar between the SPPs and APR groups (38% vs 39%; RR 0.98, 95% CI 0.77‐1.27). Margin involvement was present in eight patients in the SPPs group (one and seven at the distal and radial margins, respectively) and in 12 patients in the APR group. No difference in 3‐year local recurrence rate was noted between the two groups (11% vs 14%; HR 0.77, 95% CI 0.42‐1.41). In this observational study, comparability was ensured by adjusting for possible confounding factors. Our results suggest that SPPs and APR for locally advanced low rectal cancer have demonstrably equivalent oncological local control.

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“…One of the principal difficulties of the laparoscopic approach is the limited space in the pelvis in which to operate, particularly in the male and with low-lying rectal tumours. Several case series and trials have demonstrated the safety and feasibility of the laparoscopic approach for rectal cancer [55][56][57][58][59][60][61][62][63]. These trials suggest that laparoscopic surgery affords similar oncological results to open surgery with less blood loss, have shorter recovery periods but take longer to perform.…”

Section: Management Of Early Rectal Cancer and The Malignant Polypmentioning

confidence: 99%

Paradigm Shift in the Management of Rectal Cancer

Rawat

Evans

2014

Indian J Surg

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Surgery for rectal cancer in the pre-Total Mesorectal Excision (TME) era was associated with high local recurrence rates. The widespread adoption of the TME technique together with the addition of neoadjuvant oncological therapies have reduced local failure rates and improved survival for patients with rectal cancer. Advances in our knowledge, better understanding of tumour biology and refinement in minimal access techniques and equipment have significantly changed the management of rectal cancer. This paper reviews these changes and proposes a paradigm shift in how rectal cancer management is conceptualised and treated, such that the treatment of rectal cancer is separated into early tumours (potentially suitable for local excison), TME tumours (optimally managed by TME) and beyond TME tumours (optimally managed by multivisceral resection outside the TME plane).

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Randomized Trial of Laparoscopic-Assisted Resection of Colorectal Carcinoma: 3-Year Results of the UK MRC CLASICC Trial Group

Cited by 1,405 publications

References 21 publications

Prospective Randomized Study Comparing Robotic-Assisted Surgery with Traditional Laparotomy for Rectal Cancer—Indian Study

Prospective Randomized Study Comparing Robotic-Assisted Surgery with Traditional Laparotomy for Rectal Cancer—Indian Study

Local control of sphincter‐preserving procedures and abdominoperineal resection for locally advanced low rectal cancer: Propensity score matched analysis

Paradigm Shift in the Management of Rectal Cancer

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