A La CaRT: Australasian Phase III Randomised Trial Comparing Laparoscopic-assisted Versus Open Resection For Rectal Cancer
Funder
National Health and Medical Research Council
Funding Amount
$974,440.00
Summary
The current major treatment for rectal cancer is surgical removal of the cancer. This type of surgery requires a large cut through the abdomen for removal of the cancer. There is a newer, less invasive procedure known as laparoscopic resection enabling the same surgery by using a scope inserted in the abdomen along with a smaller incision to allow removal of the tumour. This study is being conducted to determine whether the newer procedure is as safe and effective as the current procedure.
Randomised Controlled Trials Of Laparoscopic Techniques For Antireflux Surgery
Funder
National Health and Medical Research Council
Funding Amount
$1,031,381.00
Summary
Gastro-oesophageal reflux is common, with approximately 10% of Australians now using medication to control symptoms. Many Australians will need this medication for life, unless they undergo surgery. The cost of treating reflux is growing. Since 1992 the annual growth rate of the Pharmaceutical Benefits Scheme expenditure on reflux medication has been 13%, and the annual cost for the treatment of reflux now exceeds $1 billion. Not all patients with reflux are satisfied with medication, as some co ....Gastro-oesophageal reflux is common, with approximately 10% of Australians now using medication to control symptoms. Many Australians will need this medication for life, unless they undergo surgery. The cost of treating reflux is growing. Since 1992 the annual growth rate of the Pharmaceutical Benefits Scheme expenditure on reflux medication has been 13%, and the annual cost for the treatment of reflux now exceeds $1 billion. Not all patients with reflux are satisfied with medication, as some continue to experience symptoms. Surgery is the only treatment which will cure reflux. It has a clear role in the treatment of patients with ongoing symptoms, those who don t want to take tablets, and patients with a large hiatus hernia in whom symptoms occur due to the relocation of the stomach from the abdomen into the chest. Approximately 5,000 Australians per year undergo surgery for reflux. The standard operation achieves a good outcome in approximately 90%, although some patients are troubled by side effects. To reduce the risk of this, the original procedure has been modified. However, the evidence supporting modifications has until recently been limited. The best way to compare different operations is in randomised trials. The majority of the largest and best trials addressing this area have been undertaken in Adelaide. We have already entered 504 patients into 5 randomised trials, 4 conducted entirely in Adelaide, and one across multiple sites with the cooperation of 15 Australasian surgeons. These trials have provided a more reliable evidence base for surgeons undertaking surgery for reflux. However, long term follow-up is required to ensure that conclusions drawn are valid at late follow-up. In addition we are establishing 2 new randomised trials, which will determine how best to perform surgery for reflux, and how best to repair a large hiatus hernia. These studies will be undertaken in collaboration with more than 25 other surgeons throughout Australia.Read moreRead less
Development, Validation And Implementation Of A Technical And Non-technical Skills Training Curriculum For Laparoscopic Appendicectomy Surgery
Funder
National Health and Medical Research Council
Funding Amount
$41,237.00
Summary
A structured training curriculum will be developed that can teach novice surgeons in key surgical and decision-making skills required for laparoscopic appendectomy surgery (key-hole removal of the appendix). An assessment tool that can quantitatively evaluate performance during a laparoscopic appendectomy will be developed. Using this, the ability of the developed training curriculum to improve the performance of trainee surgeons during actual laparoscopic appendectomy surgery will be evaluated.
AUSTRALASIAN MULTICENTRED PROSPECTIVE RANDOMISED STUDY OF LAPAROSCOPIC VS CONVENTIONAL SURGICAL TREATMENT OF COLON CA
Funder
National Health and Medical Research Council
Funding Amount
$495,000.00
Summary
Colon cancer is one of the most common solid tumours in western society. The usual initial treatment is excision of the cancer by an operation done through a cut down the midline of the abdominal wall. Over the past 10 years, minimally invasive technology has changed the approach to many surgical operations. A good example of this is an operation to remove the gall bladder. This is now routinely done using a laparoscope (telescope) which is introduced at the umbilicus. An image on a video screen ....Colon cancer is one of the most common solid tumours in western society. The usual initial treatment is excision of the cancer by an operation done through a cut down the midline of the abdominal wall. Over the past 10 years, minimally invasive technology has changed the approach to many surgical operations. A good example of this is an operation to remove the gall bladder. This is now routinely done using a laparoscope (telescope) which is introduced at the umbilicus. An image on a video screen of the gall bladder is then used to guide instruments to remove the gall bladder without making a large incision in the abdominal wall. This is called a laparoscopic cholecystectomy. The safety of a laparoscopic assisted approach in the removal of colon cancer is yet to be determined. This study will compare the long term and short term outcomes of people who have colon cancers removed either by a laparotomy (a cut in the midline of the abdominal wall) or by a laparoscopic assisted approach (telescope).Read moreRead less
Total Laparoscopic Hysterectomy (TLH) Vs. Total Abdominal Hysterectomy (TAH) For The Treatment Of Endometrial Cancer
Funder
National Health and Medical Research Council
Funding Amount
$809,860.00
Summary
The LACE study is a clinical trial comparing two types of surgery for women with early-stage cancer of the inner lining of the uterus, known as endometrial cancer. Treatment for endometrial cancer involves removal of the uterus, tubes, ovaries and lymph nodes. Traditionally this has been performed by open surgery via an abdominal incision. Open surgery is effective for endometrial cancer, but it is highly invasive, resulting in visible scarring, tissue damage, blood loss and a fairly high risk o ....The LACE study is a clinical trial comparing two types of surgery for women with early-stage cancer of the inner lining of the uterus, known as endometrial cancer. Treatment for endometrial cancer involves removal of the uterus, tubes, ovaries and lymph nodes. Traditionally this has been performed by open surgery via an abdominal incision. Open surgery is effective for endometrial cancer, but it is highly invasive, resulting in visible scarring, tissue damage, blood loss and a fairly high risk of complications. Laparoscopic surgery, commonly referred to as keyhole surgery, is a new approach to removing the uterus, tubes, ovaries and lymph nodes. Preliminary results from this less invasive surgery have been extremely encouraging. Laparoscopic surgery is practical and safe in treating endometrial cancer, while also resulting in less tissue damage, lower blood loss, less pain and a shorter recovery period in hospital. The LACE study aims to give definitive answers about the results offered by laparoscopic surgery in treating women with early stage endometrial cancer. The primary aim is to investigate whether the treatment of endometrial cancer using laparoscopic surgery is as good as that using open surgery. Secondary aims look at whether laparoscopic surgery provides more benefits compared to open surgery for endometrial cancer, such as: - improvements in the quality of life post-surgery, - reduced number of early and late surgery-related complications, - shorter stays in hospital, - fewer blood transfusions required, - less pain post-surgery, and hence fewer pain-killers. The LACE study is already under way, with recruitment on target for Stage 1. This application seeks funding for Stage 2, to expand recruitment from 2007. The outcomes of the trial will have a significant bearing on the future choice of treatment for endometrial cancer. Therefore the study will impact many patients around the world, including ~2000 women every year in Australia.Read moreRead less
Australasian Randomised Clinical Trial Comparing Laparoscopic And Open Surgical Treatment Of Colon Cancer: Follow-up.
Funder
National Health and Medical Research Council
Funding Amount
$233,000.00
Summary
Colon cancer is one of the most common solid tumours in western society. The usual initial treatment is excision of the cancer by an operation done through a cut down the midline of the abdominal wall. Over the past 15 years, minimally invasive technology has changed the approach to many surgical operations. A good example of this is an operation to remove the gall bladder. This is now routinely done using a laparoscope (telescope) which is introduced at the umbilicus. An image on a video screen ....Colon cancer is one of the most common solid tumours in western society. The usual initial treatment is excision of the cancer by an operation done through a cut down the midline of the abdominal wall. Over the past 15 years, minimally invasive technology has changed the approach to many surgical operations. A good example of this is an operation to remove the gall bladder. This is now routinely done using a laparoscope (telescope) which is introduced at the umbilicus. An image on a video screen of the gall bladder is then used to guide instruments to remove the gall bladder without making a large incision in the abdominal wall. This is called a laparoscopic cholecystectomy. The safety of a laparoscopic assisted approach in the removal of colon cancer is yet to be determined. This study will compare the long term and short term outcomes of people who have colon cancers removed whether by laparotomy ( a cut in the midline of the abdominal wall) or by a laparoscopic assisted approach (telescope).Read moreRead less
Alternative Insufflation Gases For Laparoscopic Surgery
Funder
National Health and Medical Research Council
Funding Amount
$227,036.00
Summary
It is now recognised that laparoscopic (keyhole) surgery for cancer can be associated with the spread of tumour to surgical wounds, i.e. port sites. However, whether this is more likely following laparoscopy than conventional open surgery is controversial. Isolated case reports and the recent results of experimental studies suggest that the problem is important. Previous studies suggest that carbon dioxide gas used to inflate the abdomen during laparoscopy may be the specific cause of this probl ....It is now recognised that laparoscopic (keyhole) surgery for cancer can be associated with the spread of tumour to surgical wounds, i.e. port sites. However, whether this is more likely following laparoscopy than conventional open surgery is controversial. Isolated case reports and the recent results of experimental studies suggest that the problem is important. Previous studies suggest that carbon dioxide gas used to inflate the abdomen during laparoscopy may be the specific cause of this problem. A four to fivefold increase in the rate of cancer spread has been shown in previous experiments, and this can be reduced by using an inert gas such as helium. We propose to further investigate this issue using a combination of small and large animal models, and will also commence clinical trials of helium during clinical surgery. These studies aim will determine the gas of choice during laparoscopic surgery. They will also clarify advantages demonstrated for the use of helium in previous animal studies, and better investigate the safety of helium use. If our preliminary findings are supported by these studies, helium (or other inert gases) should be considered for routine use during clinical laparoscopy.Read moreRead less