Adhesions and incisional hernias following laparoscopic <i>versus</i> open surgery for colorectal cancer in the CLASICC trial

Taylor, Gregory; Jayne, David; Brown, Sarah; Thorpe, Helen; Brown, Julia; Dewberry, Sean; Parker, Michael; Guillou, P. J.

doi:10.1002/bjs.6742

Cited by 157 publications

(102 citation statements)

References 22 publications

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“…However, it is possible to argue that participating surgeons by learning laparoscopic technique where dissection in the correct anatomical planes is essential for success, used this technique also in the open cases, and thus the patients in the openly operated group also benefited from an atraumatic surgical technique. The result of this study is similar to the recent report from the CLASICC trial-another of the randomized trials of laparoscopic versus open surgery, but for colorectal cancer, with similar protocol and a somewhat smaller sample [27].…”

Section: Discussionsupporting

confidence: 87%

Bowel obstruction after laparoscopic and open colon resection for cancer: Results of 5 years of follow-up in a randomized trial

et al. 2011

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Background Postoperative bowel obstruction caused by intra-abdominal adhesions occurs after all types of abdominal surgery. It has been suggested that the laparoscopic technique should reduce the risk for adhesion formation and thus for postoperative bowel obstruction. This study was designed to compare the incidence of bowel obstruction in a randomized trial where laparoscopic and open resection for colon cancer was compared. Methods A retrospective analysis was performed, collecting data of episodes of bowel obstruction with or without surgery. Only episodes treated in the hospital where the index surgery took place were included. Data for 786 patients were collected for the 5-year period after cancer surgery. Results Baseline characteristics for the evaluated laparoscopic (n = 383) and open (n = 403) groups were comparable. The cumulative obstruction percentages at 5 years for the open and laparoscopic groups were 6.5 and 5.1% respectively and did not significantly differ from each other. Tumor stage seemed to influence the risk for bowel obstruction: 2.8% in stage I, 6.6% in stage II, and 7% in stage III, but the differences were not significant. Conclusions This analysis does not support the hypothesis that laparoscopy leads to fewer episodes of bowel obstruction compared with open surgery.Surgical trauma is the cause of more than 90% of intraabdominal adhesions, and approximately 30% of patients who undergo major surgery develop postoperative

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Section: Discussionsupporting

confidence: 87%

Bowel obstruction after laparoscopic and open colon resection for cancer: Results of 5 years of follow-up in a randomized trial

et al. 2011

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“…At least four other smaller, non‐population‐based studies11, 12, 13, 14 found no difference in risk of surgery for SBO or adhesive SBO according to surgical approach in colorectal surgery, although one study12 evaluated only colonic resections.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies4 7, 8, 9, 10 have suggested an advantage for laparoscopic surgery, whereas others11, 12, 13, 14 have found no difference in the risk of adhesive SBO after open or laparoscopic surgery. Only two studies4 15 have compared the risk of surgery for adhesive SBO following laparoscopic or open rectal surgery.…”

Section: Introductionmentioning

confidence: 99%

Nationwide population-based cohort study to assess risk of surgery for adhesive small bowel obstruction following open or laparoscopic rectal cancer resection

et al. 2017

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BackgroundLaparoscopic surgery has been reported to reduce the formation of adhesions following colorectal surgery. The aim of this nationwide cohort study was to investigate the risk of surgery for adhesive small bowel obstruction (SBO) following open and laparoscopic rectal cancer resection.MethodsPatients undergoing rectal cancer resection between 2005 and 2013 were identified in the Danish Colorectal Cancer Group database. The primary outcome of surgery for adhesive SBO was identified in the Danish National Patient Registry. The risk of surgery for adhesive SBO was estimated as the cumulative incidence proportion, treating death as a competing risk. Cox proportional hazards regression analysis with multivariable adjustment was used to compute hazard ratios (HRs). The secondary outcome was 30‐day mortality after surgery for adhesive SBO.ResultsOf 7657 patients, 340 (4·4 per cent) underwent surgery for adhesive SBO. The 5‐year risk of surgery for adhesive SBO was 4·5 per cent among 4472 patients undergoing open resection and 3·0 per cent among 3185 patients having a laparoscopic resection. Laparoscopic rectal resection was associated with a lower risk of subsequent operation for adhesive SBO (adjusted HR 0·65, 95 per cent c.i. 0·50 to 0·86; P = 0·002). The adjusted HR of mortality after adhesive SBO was 0·84 (0·37 to 1·91; P = 0·671) comparing patients with previous laparoscopic and open resection.ConclusionLaparoscopic rectal cancer resection was associated with a decreased risk of surgery for adhesive SBO. There was a substantial difference in 30‐day mortality after surgery for adhesive SBO based on the surgical approach used at the time of rectal resection.

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“…We identified 20 potential RCTs comparing LRS with ORS for rectal cancer, of which, four studies were excluded for repeatedly published (Liang et al, 2010), outcomes of interest not studied (Buunen et al, 2009;Taylor et al, 2010) and data not available based on rectal cancer in trial of colorectal cancer (Kitano et al, 2005) (Figure 1). 16 RCTs (Araujo et al, 2003;Zhou et al, 2004;Guillou et al, 2005;Braga et al, 2007;Jayne et al, 2007;Pan et al, 2007;Pechlivanides et al, 2007;Ng et al, 2008;Lujan et al, 2009;Ng et al, 2009;Kang et al, 2010;Liang et al, 2011;Zhang et al, 2012;Green et al, 2013;van der Pas et al, 2013) involving 3045 participants met the inclusion criteria were included in this meta-analysis, published year ranged from 2003 to 2013.…”

Section: Studies Selectedmentioning

confidence: 99%

Laparoscopic Versus Open Surgery for Rectal Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Zhang

Zhou²,

Wang³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Adhesions and incisional hernias following laparoscopic versus open surgery for colorectal cancer in the CLASICC trial

Cited by 157 publications

References 22 publications

Bowel obstruction after laparoscopic and open colon resection for cancer: Results of 5 years of follow-up in a randomized trial

Bowel obstruction after laparoscopic and open colon resection for cancer: Results of 5 years of follow-up in a randomized trial

Nationwide population-based cohort study to assess risk of surgery for adhesive small bowel obstruction following open or laparoscopic rectal cancer resection

Laparoscopic Versus Open Surgery for Rectal Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials

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