Transforming the surgical treatment of colorectal cancer

Academics: Professor P.J. Guillou, Professor D.G. Jayne and Professor J.M. Brown, Faculty of Medicine and Health

University of Leeds research confirmed the effectiveness and safety of laparoscopic - or ‘keyhole’ - surgery in treating colorectal cancer. The research has shaped healthcare policy internationally and has led to the UK becoming one of the largest providers of laparoscopic colorectal cancer surgery in the world.

Colorectal cancer is the third most common cancer in the UK, affecting just under 40,000 people a year, and surgery is the main treatment. When laparoscopic surgery was introduced in the1980s, there was little rigorous scientific evaluation. There were clear potential benefits as patient recovery was quicker than with open surgery, but concerns existed regarding its safety and efficacy, particularly in the treatment of malignant disease.

Pioneering trial 

Researchers at Leeds initiated the UK Medical Research Council trial of Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer (CLASICC). A UK-wide, multicentre clinical trial, CLASICC was set up to address the huge clinical uncertainty regarding the safety and efficacy of laparoscopic surgery and provide a rigorous evaluation of the new technology. It conclusively demonstrated that laparoscopic colorectal cancer surgery is as safe as open surgery, with short-term benefits for patients, and similar long-term oncological outcomes.

The largest and most successful UK trial of a technology applied to general surgery, CLASICC is regarded as a benchmark surgical trial, combining high quality design with rigorous quality assurance, which has set the standard for evaluating new surgical techniques by randomised comparison.

Successfully spreading surgical innovation 

The impact of CLASICC has been global, confirming the advantages for patients (quicker recovery) and healthcare providers (cost-savings) and so influencing national and international policy. It informed NICE guidance and led to a major Department of Health initiative that has seen laparoscopic resections undertaken in the NHS increase from 10% in 2009 to 40% by 2012. Laparoscopic surgery results in a reduction in hospital stay which equates to 17,000 bed-days saved per year, or around £7.5 million.

Internationally, CLASICC has informed policy and has led to laparoscopic surgery being accepted as the preferred treatment for colorectal cancer, making this minimally invasive technology available to patients worldwide. 

Laparoscopic surgery for colorectal cancer is quickly becoming the standard of care throughout the NHS, with the 40% UK adoption rate being one of the highest in the world.

Funders: Medical Research Council and National Institute for Health Research