NICE Guidelines

We have outlined below the summary of 2006 NICE Guidance on Laparoscopic Colorectal Surgery, along with the supplemental 2009 NICE Guidance Waiver review.

(See  for full details)

1    Guidance
1.1    Laparoscopic (including laparoscopically assisted) resection is recommended as an alternative to open resection for individuals with colorectal cancer in whom both laparoscopic and open surgery are considered suitable.

1.2    Laparoscopic colorectal surgery should be performed only by surgeons who have completed appropriate training in the technique and who perform this procedure often enough to maintain competence. The exact criteria to be used should be determined by the relevant national professional bodies. Cancer networks and constituent Trusts should ensure that any local laparoscopic colorectal surgical practice meets these criteria as part of their clinical governance arrangements.

1.3    The decision about which of the procedures (open or laparoscopic) is undertaken should be made after informed discussion between the patient and the surgeon. In particular, they should consider:

  • the suitability of the lesion for laparoscopic resection
  • the risks and benefits of the two procedures
  • the experience of the surgeon in both procedures.

Letter to All Trust Chief Executives in England from Prof. Mike Richards, National Cancer Director

Gateway Approval Required:  Information/Good Practice

Letter to:  NHS Chief Executives. NHS FD Trust/Trust Medical Directors

Dear Colleague,

Re: National Training Programme (NTP) in Laparoscopic Colorectal Cancer Surgery – Supporting NICE Technology Appraisal (2006) recommendations for laparoscopic resection for colorectal cancer

In August 2006, NICE issued a technology appraisal recommending laparoscopic resection as an alternative to open surgery for people with colorectal cancer in whom both procedures were suitable.  NICE estimated that the surgery would result in shorter bed stays and significantly improve the patient experience.  On 31 October 2006, the Department of Health waived the 3-month funding direction to implement this appraisal as it was recognised that there were insufficient surgeons trained in the procedure.  The waiver is due to be reviewed in 2009.

As part of the Cancer Reform Strategy implementation plans the Department of Health and the National Cancer Action Team have developed and funded a programme to train colorectal surgeons to a level of competence in laparoscopic surgery to perform such procedures independently and safely.

As we now have the mechanism in place to train consultant surgeons we would urge you to support all your colorectal surgeons and their teams already in training or who wish to start training, to enrol in the national programme. The programme offers surgeons a flexible, supportive and tailored package of training accompanied by a means of acknowledging the level of competence achieved.

Ten training centres based in 16 hospitals have been appointed to deliver the programme, which will allow the NHS to build up the expertise to ensure that the existing colorectal consultant surgeon workforce is trained to deliver high quality colorectal cancer surgery in line with the NICE appraisal.
The attached management note gives further details on the background and suggests actions the NHS will want to undertake.  The NICE appraisal was very clear that patients should be able to make an informed choice between open or laparoscopic procedures following discussion with their surgeon.

If you have further questions or wish to open up this opportunity to your surgeons, please contact the National Clinical Lead, Mark Coleman, or the coordination office in Plymouth.

Yours faithfully,

Prof. Mike Richards
National Cancer Director
Mr Mark Coleman
National Clinical Lead – NTP

Colorectal Cancer Networks
Teresa Moss – NCAT
Glenis Freeman – DH Cancer Programme
ACP Regional Chapter Representatives

Summary of 2009 NICE Guidance Waiver - LETTER (please click to view)