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Long Term Outcomes following Laparoscopic Colorectal Surgery
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Long Term Outcomes following Laparoscopic Colorectal Surgery

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Peter Hewett …

Peter Hewett
The Queen Elizabeth Hospital
Adelaide

Published in Health & Medicine , Technology
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  • 1. Long Term Outcomes following Laparoscopic Colorectal Surgery Peter Hewett The Queen Elizabeth Hospital Adelaide
  • 2. Long term outcomes following Laparoscopic Colorectal Surgery
    • Malignant Disease
    • Colon and Rectum
    • Oncological outcomes
    • Incisional Hernia rates
    • Small bowel obstruction rates
  • 3.
    • Single series studies
    • Case matched studies
    • Randomised Controlled Trials
  • 4. Single series studies
    • Jacob & Salky 11 year retrospective with 5 year survival rates (Surg Endosc 2005 19 :643-649)
    • Law et al Comparison of two separate cohorts (Annals of Surgery Jan 2007 245 : 1-7)
  • 5. Single series studies
    • Jacob & Salky 11 year retrospective with 5 year survival rates (Surg Endosc 2005 19 :643-649)
    • Law et al Comparison of two separate cohorts (Annals of Surgery Jan 2007 245 : 1-7)
  • 6. Overall survival and disease free survival after laparoscopic surgery for colon cancer is no worse and perhaps better than the previously reported rates for the same procedure done by an open technique. 81 patients
  • 7. Single series studies
    • Jacob & Salky 11 year retrospective with 5 year survival rates (Surg Endosc 2005 19 :643-649)
    • Law et al Comparison of two separate cohorts (Annals of Surgery Jan 2007 245 : 1-7)
  • 8. Impact of Laparoscopic Resection for Colorectal Cancer on Operative Outcomes and Survival
    • Objective: This study aimed to compare the outcomes of patients who underwent laparoscopic and open resections for colorectal cancer. Comparison of colectomy in 2 consecutive periods (period 1: January 1996–May 2000; period 2: June 2000–December 2004), with laparoscopic surgery being a surgical option in period 2, was also performed.
  • 9. 448 open 1996-2000 656 lap assisted 2000-2004 Colon & upper rectum Overall survival
  • 10. STAGE 3
  • 11. Randomised Trials
    • Braga M et al. Colon Ca. Lap 190 Open 201 (DCR 2005 48: 2217-2223)
    • Leung KL, Kwok S, Lam S, Lee J Rectosigmoid Ca Lap 203 Open 200 (Lancet 2004 363 1187-1193)
    • Lacy A et al Colon Ca. Lap 111 Open 108 (Annals of Surgery 2008 248:1-7)
  • 12. Randomised Trials
    • Braga M et al. Colon Ca. Lap 190 Open 201 (DCR 2005 48: 2217-2223)
    • Leung KL, Kwok S, Lam S, Lee J Rectosigmoid Ca Lap 203 Open 200 (Lancet 2004 363 1187-1193)
    • Lacy A et al Colon Ca. Lap 111 Open 108 (Annals of Surgery 2008 248:1-7)
  • 13. Acturarial 5 year survival
  • 14. Randomised Trials
    • Braga M et al. Colon Ca. Lap 190 Open 201 (DCR 2005 48: 2217-2223)
    • Leung KL, Kwok S, Lam S, Lee J Rectosigmoid Ca Lap 203 Open 200 (Lancet 2004 363 1187-1193)
    • Lacy A et al Colon Ca. Lap 111 Open 108 (Annals of Surgery 2008 248:1-7)
  • 15.  
  • 16. Randomised Trials
    • Braga M et al. Colon Ca. Lap 190 Open 201 (DCR 2005 48: 2217-2223)
    • Leung KL, Kwok S, Lam S, Lee J Rectosigmoid Ca Lap 203 Open 200 (Lancet 2004 363 1187-1193)
    • Lacy A et al Colon Ca. Lap 111 Open 108 (Annals of Surgery 2008 248:1-7)
  • 17. *
  • 18.  
  • 19. Multicentered Randomised Controlled Trials
    • COST
    • COLOR
    • CLASSIC
    • ALCCaS
  • 20. Multicentered Randomised Controlled Trials
    • COST
    • COLOR
    • CLASSIC
    • ALCCaS
  • 21. COST
    • 872 patients
    • 5 year data on 90% of patients
    • Primary endpoint : time to recurrence
    • Secondary endpoints : overall survival and disease free survival.
    • Noninferiority trial design
  • 22. Conclusion. Laparoscopic colectomy for cancer is not inferior to open surgery.
  • 23.  
  • 24. Multicentered Randomised Controlled Trials
    • COST
    • COLOR
    • CLASSIC
    • ALCCaS
  • 25. CLASSIC TRIAL 3 year survival figures
    • 3 year overall survival similar
    • Colon and rectal cancer
    • Lap assisted vs open
    • Anterior resection local recurrence rate 7.0% open & 7.8% lap assisted
    • Wound/port site recurrence 9 lap:1 open
    • QOL. No difference
    • Jayne et al J Clin Oncology 2007 25(21) 2996-8
  • 26.  
  • 27. Multicentered Randomised Controlled Trials
    • COST
    • COLOR
    • CLASSIC
    • ALCCaS
  • 28. Transantlantic Laparoscopically Assisted vs Open Colectomy Trials Study Group
    • Combined analysis of data of the Barcelona Trial, COST, CLASSIC & COLOR trials.
    • Overall & Disease free survival @ 3 years
    • Curative surgery for colon cancer before March 2000.
    • 796 lap assisted & 740 open
  • 29.  
  • 30.  
  • 31.  
  • 32. *
  • 33.  
  • 34.  
  • 35. Long Term Outcomes following Laparoscopic Colorectal Surgery Study Interpretation
    • Study bias
    • Subgroup error
    • Patient Selection
    • Site Selection
    • Surgeon Selection
    • Investigator bias (Hawthorne effect)
  • 36. Long Term Outcomes following Laparoscopic Colorectal Surgery Equipoise?
    • 3 year disease and overall survival is the same between lap assisted and open colectomy.
    • For surgeons and patients globally the current standard of care has not changed.
    • Surgeons can continue to offer laparoscopic assisted colectomy while awaiting 5 year survival statistics.
    • Different skills & experience to perform lap rectal resection
  • 37. ALCCaS Trial
    • Short-Term Outcomes of the Australasian Randomized Clinical Study Comparing Laparoscopic and Conventional Open Surgical Treatments for Colon Cancer: The ALCCaS Trial.
    • Hewett, Peter J. FRACS ; Allardyce, Randall A. PhD ; Bagshaw, Philip F. FRCS ; Frampton, Christopher M. PhD [S]; Frizelle, Francis A. FACS ; Rieger, Nicholas A. FRACS *; Smith, J Shona MA(Hons) ; Solomon, Michael J. FRACS ; Stephens, Jacqueline H. MPH ; Stevenson, Andrew R. L. FRACS
    • Annals of Surgery 2008 Vol 248 No 5
    • 5 year survival figures available April 2010
  • 38.