title: The influence of NICE guidance on the uptake of laparoscopic surgery for colorectal cancer.
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.
authors.affiliation: Faculty of Medicine and Dentistry, University of Bristol Medical School, Bristol BS2 8DZ, UK.
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Green
authors.forename: Roy
authors.initials: R
authors.lastname: Maxwell
authors.forename: Julia
authors.initials: J
authors.lastname: Verne
authors.forename: Richard M
authors.initials: RM
authors.lastname: Martin
authors.forename: Jane M
authors.initials: JM
authors.lastname: Blazeby