2 Clinical need and practice

Guidance

2.1 Colorectal cancer (cancer arising in the lining of the colon or rectum) is the third most common cancer in the UK. Almost 30,000 new cases were registered in England and Wales in 2002, representing over 12% of all new cancer cases. The incidence of colorectal cancer increases with age. In people between the ages of 45 and 49 years, the incidence is about 20 per 100,000. In those aged 75 and older, the annual incidence is over 300 cases per 100,000 men and over 200 cases per 100,000 women.

2.2 Complete surgical excision of the tumour is the only potential cure and is indicated in 70% to 80% of diagnosed individuals. The remaining 20% to 30% usually have disease that has advanced to the extent that surgical resection with curative intent is unlikely to be successful. Among those who undergo surgery, the majority have a good prognosis while about 30% will go on to develop advanced disease and metastases despite having apparently complete initial resection. For those with advanced disease, treatment is mainly palliative, aiming to increase the duration and quality of the person's life while controlling symptoms.

2.3 The current standard procedure for the surgical resection of primary colorectal tumours uses the open approach, which involves open laparotomy and removal of the tumour via the abdominal incision. Part or all of the large intestine is removed, depending on the site and extent of the tumour. This procedure is associated with significant postoperative pain and usually involves a long hospital stay. While techniques such as epidural analgesia can effectively control postoperative pain, associated complications may require high-dependency care.