Guillou PJ et al. (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomized controlled trial. Lancet 365: 1718–1726

Initial results of the CLASICC trial have recently been presented in the Lancet by Guillou and co-workers. This study aimed to compare the short-term outcomes of laparoscopic resection with those of conventional open surgery in patients with colorectal cancer and to make predictions for long-term implications of the laparoscopic-assisted procedure. Patients with cancer of the colon or rectum were recruited from 27 UK centers between July 1996 and July 2002 and were randomized 2:1 to undergo either open or laparoscopic bowel surgery.

Of 794 randomized patients, 737 underwent surgery; 253 in the laparoscopy group and 484 in the open surgery group. Crossover from laparoscopy to open surgery occurred in 143 patients. There was no significant difference between the two groups in the proportion of Duke's C2 tumors, in-hospital mortality, number of positive circumferential resection margins, complications during and after surgery, transfusion requirements, or quality of life. Rectal cancer and conversion to the laparoscopic procedure were associated with an increased frequency of intraoperative complications, and conversion during surgery resulted in a slightly higher death rate, although neither of these trends were significant.

The authors conclude that, in the short-term, laparoscopic resection and conventional surgery are comparably effective in patients with colon cancer, and they do not predict that long-term outcomes will differ significantly. However, they recommend that the decision to routinely adopt laparoscopic-assisted surgery for patients with rectal cancer should not be taken until further data are available: 3-year cancer-related mortality and disease-free survival are currently being analyzed.