CLASICC Trial (Lancet 2005)
This is a UK multicentre randomised trial that aimed to compare conventional open surgery against laparoscopic assisted. Participating surgeons had to have performed at least 20 laparoscopic resections before entering the study.
794 people were recruited of which 268 and 526 were randomised to open and laparoscopic surgery; 253 and 488 respectively then went on to have their designated treatment.
29% of laparoscopic patients underwent intraoperative conversion to open surgery. The most common reason cited was tumour fixity? Conversion fell from 38% in year 1 to 16% in year 6.
There were no differences between the groups in terms of +ve rate of resection margins (CRM), proportion of Dukes' C2 tumours, in-hospital mortality, inta-operative and postoperative complications and QOLife over 3 months. Complications were highest for rectal resections (13% vs 7%) and those who underwent a conversion (p=0.002).
A non-significant increase in positive CRM was seen for lap anterior resection for rectal cancer compared to open surgery (12% vs 6%, p=0.19).
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, Heath RM, Brown JM. Lancet 2005; 365: 1718-26.