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Laparoscopic Colorectal Surgery Outcomes Improved After National Training Program (LAPCO) for Specialists in England

Hanna, George B.; Mackenzie, Hugh; Miskovic, Danilo; Ni, Melody; Wyles, Susannah; Aylin, Paul; Parvaiz, Amjad; Cecil, Tom; Gudgeon, Andrew; Griffith, John; Robinson, Jonathan M.; Selvasekar, Chelidah; Rockall, Tim; Acheson, Austin; Maxwell-Armstrong, Charles; Jenkins, John T.; Horgan, Alan; Cunningham, Chris; Lindsay, Ian; Arulampalam, Tan; Motson, Roger W.; Francis, Nader K.; Kennedy, Robin H.; Coleman, Mark G.

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George B. Hanna

Hugh Mackenzie

Danilo Miskovic

Melody Ni

Susannah Wyles

Paul Aylin

Amjad Parvaiz

Tom Cecil

Andrew Gudgeon

John Griffith

Jonathan M. Robinson

Chelidah Selvasekar

Tim Rockall

Clinical Associate Professor

Charles Maxwell-Armstrong

John T. Jenkins

Alan Horgan

Chris Cunningham

Ian Lindsay

Tan Arulampalam

Roger W. Motson

Nader K. Francis

Robin H. Kennedy

Mark G. Coleman


To examine the impact of The National Training Programme for Laparoscopic Colorectal Surgery (Lapco) on the rate of laparoscopic surgery and clinical outcomes of cases performed by Lapco surgeons after completion of training.

Lapco provided competency-based supervised clinical training for specialist colorectal surgeons in England.

We compared the rate of laparoscopic surgery, mortality and morbidity for colorectal cancer resections by Lapco delegates and non-Lapco surgeons in 3-year periods preceding and following Lapco using difference in differences analysis. The changes in the rate of post-Lapco laparoscopic surgery with the Lapco sign-off competency assessment and in-training global assessment scores were examined using risk-adjusted cumulative sum to determine their predictive clinical validity with predefined competent scores of 3 and 5 respectively.

108 Lapco delegates performed 4586 elective colorectal resections pre-Lapco and 5115 post-Lapco while non-Lapco surgeons performed 72930 matched cases. Lapco delegates had a 37.8% increase in laparoscopic surgery which was greater than non-Lapco surgeons by 20.9% (95% CI, 18.5 to 23.3, p [less than] 0.001) with a relative decrease in 30-day mortality by -1.6% (95% CI, -3.4 to -0.2, p = 0.039) and 90-day mortality by -2.3% (95% CI, -4.3 to -0.4, p = 0.018). The change point of risk-adjusted cumulative sum was 3.12 for competency assessment tool and 4.74 for global assessment score whereas laparoscopic rate increased from 44% to 66% and 40% to 56% respectively.

Lapco increased the rate of laparoscopic colorectal cancer surgery and reduced mortality and morbidity in England. In-training competency assessment tools predicted clinical performance after training.


Hanna, G. B., Mackenzie, H., Miskovic, D., Ni, M., Wyles, S., Aylin, P., …Coleman, M. G. (2022). Laparoscopic Colorectal Surgery Outcomes Improved After National Training Program (LAPCO) for Specialists in England. Annals of Surgery, 275(6), 1149-1155.

Journal Article Type Article
Acceptance Date Oct 6, 2020
Online Publication Date Oct 19, 2020
Publication Date Jun 1, 2022
Deposit Date Dec 16, 2020
Publicly Available Date Oct 20, 2021
Journal Annals of Surgery
Print ISSN 0003-4932
Electronic ISSN 1528-1140
Publisher Lippincott, Williams & Wilkins
Peer Reviewed Peer Reviewed
Volume 275
Issue 6
Pages 1149-1155
Keywords Surgery
Public URL
Publisher URL
Additional Information This is not the final published version.


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