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Journal of Public Health Advance Access published online on March 25, 2009
Journal of Public Health, doi:10.1093/pubmed/fdp027
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© The Author 2009, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

The influence of NICE guidance on the uptake of laparoscopic surgery for colorectal cancer


Chris J. Green, Medical Student1
Roy Maxwell, Senior Public Health Intelligence Analyst2,3
Julia Verne, Deputy Regional Director of Public Health and Director South West Public Health Observatory3
Richard M. Martin, Professor of Clinical Epidemiology2
Jane M. Blazeby, Professor of Surgery and Honorary Consultant Upper GI Surgeon2,4

1 University of Bristol Medical School, Faculty of Medicine and Dentistry, Bristol, BS2 8DZ, UK
2 Department of Social Medicine, University of Bristol, 39-41 St. Michaels Hill, Bristol BS8 2PS, UK
3 South West Public Health Observatory, Grosvenor House, 149 Whiteladies Road, Bristol BS6 2RA, UK
4 Division of Surgery, Head and Neck, University Hospitals Bristol, NHS Foundation Trust, Bristol BS2 8HW, UK


Author for correspondence to Jane M. Blazeby, E-mail: j.m.blazeby{at}bristol.ac.uk


  Abstract

Background The National Institute for Health and Clinical Excellence (NICE) did not recommend laparoscopic surgery for colorectal cancer in 2000, but updated its guidance in 2006. We investigated the uptake of laparoscopic surgery for colorectal cancer before and after NICE guidance in 2000 and 2006.

Methods Using hospital episode statistics (HES) data for men and women in England, the annual percentages of open and laparoscopic resections for colorectal cancer were calculated between 1997 and 2007.

Results A total of 182 191 patient spells containing a diagnosis of colorectal cancer plus either a procedure code for surgical resection of the large bowel and/or a laparoscopic procedure were identified: 177 537 (97.4%) were for open resection; 4193 (2.3%) for laparoscopic surgery; and for 461 (0.3%) the procedure was unclear. The annual number of open procedures performed remained stable, whereas the numbers of laparoscopic resections increased steadily.

Conclusions Despite NICE guidance in 2000 recommending open surgery for colorectal cancer, there was a continuous increase in the laparoscopic approach in England, starting 3 years before the modified guidance supporting this technique. Whether NICE guidance was an effective deterrent and the guidelines protected patients cannot be determined from this retrospective study, but a similar staged approach for the adoption of other complex laparoscopic procedures is recommended.

Keywords: colorectal cancer, laparoscopic surgery, NICE guidelines


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