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

David G. Jayne, Pierre J. Guillou, Helen Thorpe, Philip Quirke, Joanne Copeland, Adrian M.H. Smith, Richard M. Heath, Julia M. Brown

From the Academic Unit of Surgery, St James's University Hospital; Clinical Trials Research Unit, Leeds Institute of Molecular Medicine, University of Leeds; and the Academic Unit of Pathology, University of Leeds, Leeds, United Kingdom

Address reprint requests to David G. Jayne, MD, Academic Unit of Surgery, Level 8, Clinical Sciences Bldg, St James's University Hospital, Beckett St, Leeds, LS9 7TF United Kingdom; e-mail: david.jayne{at}leedsth.nhs.uk

Purpose The aim of the current study is to report the long-term outcomes after laparoscopic-assisted surgery compared with conventional open surgery within the context of the UK MRC CLASICC trial. Results from randomized trials have indicated that laparoscopic surgery for colon cancer is as effective as open surgery in the short term. Few data are available on rectal cancer, and long-term data on survival and recurrence are now required.

Methods The United Kingdom Medical Research Council Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer (UK MRC CLASICC; clinical trials number ISRCTN 74883561) trial study comparing conventional versus laparoscopic-assisted surgery in patients with cancer of the colon and rectum. The randomization ratio was 2:1 in favor of laparoscopic surgery. Long-term outcomes (3-year overall survival [OS], disease-free survival [DFS], local recurrence, and quality of life [QoL]) have now been determined on an intention-to-treat basis.

Results Seven hundred ninety-four patients were recruited (526 laparoscopic and 268 open). Overall, there were no differences in the long-term outcomes. The differences in survival rates were OS of 1.8% (95% CI, –5.2% to 8.8%; P = .55), DFS of –1.4% (95% CI, –9.5% to 6.7%; P = .70), local recurrence of –0.8% (95% CI, –5.7% to 4.2%; P = .76), and QoL (P > .01 for all scales). Higher positivity of the circumferential resection margin was reported after laparoscopic anterior resection (AR), but it did not translate into an increased incidence of local recurrence.

Conclusion Successful laparoscopic-assisted surgery for colon cancer is as effective as open surgery in terms of oncological outcomes and preservation of QoL. Long-term outcomes for patients with rectal cancer were similar in those undergoing abdominoperineal resection and AR, and support the continued use of laparoscopic surgery in these patients.

Supported by Grant No. G932812 from the UK Medical Research Council.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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• Laparoscopic and Open Surgery for Colorectal Cancer: Reaching Equipoise?
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  JCO 2007 25: 2996-2998 [Full Text]

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• Use of Laparoscopy for Rectal Cancer: A Word of Caution
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