• Laboratory and epidemiologic studies of fecapentaenes.

      Povey, Andrew C; Schiffman, M; Taffe, B G; Harris, C C; Carcinogenesis Department, Christie Hospital and Holt Radium Institute, Manchester, Great Britain. (1991)
      Fecapentaenes are a class of conjugated ether lipids which have been identified as the major component of human fecal mutagenicity in the Ames Salmonella mutagenesis assay. Human epidemiologic data have indicated that most healthy North American populations eating a western diet do excrete detectable levels of fecapentaenes. Excreted fecapentaene levels seem to reflect levels throughout the colonic lumen, and levels vary characteristically between individuals. Those individuals found to excrete high levels of fecapentaene appear, based on limited data, to be at decreased risk of colorectal neoplasia. Carcinogenicity studies in rats and mice have been predominantly negative, however, increased tumor incidence in mice exposed to fecapentaenes as neonates has recently been reported. Fecapentaenes are direct-acting genotoxins, which may react with DNA through free radical mechanisms, and/or aldehyde formation. Mechanisms by which fecapentaene-induced DNA damage may mediate carcinogenesis are discussed.
    • A lack of a functional NAD(P)H:quinone oxidoreductase allele is selectively associated with pediatric leukemias that have MLL fusions. United Kingdom Childhood Cancer Study Investigators.

      Wiemels, J L; Pagnamenta, A; Taylor, G M; Eden, Tim O B; Alexander, F E; Greaves, M F; Leukaemia Research Fund Centre, Institute of Cancer Research, London, United Kingdom. (1999-08-15)
      Rearrangements and fusion of the MLL gene with various alternative partner genes occur in approximately 80% of infant leukemias and are acquired during fetal hemopoiesis in utero. Similar MLL gene recombinants also occur in topoisomerase II-inhibiting drug-induced leukemias. These data have led to the suggestion that some infant leukemia may arise via transplacental fetal exposures during pregnancy to substances that form cleavable complexes with topoisomerase II and induce illegitimate recombination of the MLL gene. A structural feature shared by many topoisomerase II-inhibiting drugs and other chemicals is the quinone moiety. We assayed, by PCR-RFLP, for a polymorphism in an enzyme that detoxifies quinones, NAD(P)H:quinone oxidoreductase (NQO1), in a series (n = 36) of infant leukemias with MLL rearrangements versus unselected cord blood controls (n = 100). MLL-rearranged leukemias were more likely to have genotypes with low NQO1 function (heterozygous CT or homozygous TT at nucleotide 609) than controls (odds ratio, 2.5; P = 0.015). In contrast, no significant allele bias was seen in other groups of pediatric leukemias with TEL-AML1 fusions (n = 50) or hyperdiploidy (n = 29). In the subset of infant leukemias that had MLL-AF4 fusion genes (n = 21), the bias increase in low or null function NQO1 genotypes was more pronounced (odds ratio, 8.12; P = 0.00013). These data support the idea of a novel causal mechanism in infant leukemia involving genotoxic exposure in utero and modulation of impact on a selective target gene by an inherited allele encoding a rate-limiting step in a carcinogen detoxification pathway.
    • Lack of a relationship between colony-forming efficiency and surviving fraction at 2 Gy.

      West, Catharine M L; Davidson, Susan E; Pool, Claire; James, Roger D; Schofield, Philip F; Cancer Research Campaign Department of Radiobiology, Paterson Institute for Cancer Research, Manchester, United Kingdom. (1991-05)
      The relationship between in vitro radiation sensitivity and colony-forming efficiency has been examined for primary human tumors of the cervix, colorectum, and lymph gland. Tumors were cultured using the Courtenay-Mills soft agar clonogenic assay and radiosensitivity was assessed as surviving fraction at 2 Gy. There was no correlation between colony-forming efficiency and surviving fraction at 2 Gy, giving confidence to the use of surviving fraction at 2 Gy as a predictor of clinical outcome.
    • Lack of association between childhood common acute lymphoblastic leukaemia and an HLA-C locus dimorphism influencing the specificity of natural killer cells.

      Ghodsi, K; Taylor, G M; Gokhale, D A; Dearden, S; Stevens, R F; Birch, Jillian M; Fergusson, W D; Eden, Tim O B; Ollier, W; Immunogenetics Laboratory, St Mary's Hospital, Manchester. (1998-09)
      Previous serological studies documenting an association between acute lymphoblastic leukaemia (ALL) and HLA-Cw antigens suggested that the HLA-C locus might influence susceptibility to ALL. However, associations with more than one Cw antigen suggest that polymorphic variants shared by more than Cw allele could be involved. Recent studies have shown that the HLA-C locus encodes two ligands (NK1 and NK2) recognized by receptors on natural killer (NK) cells. HLA-Cw alleles encoding these ligands are dimorphic, dependent on whether they encode one or other NK ligand. To determine whether susceptibility to the common (CD10+) form of childhood ALL (c-ALL) is associated with NK1 or NK2, we carried out a molecular analysis of 94 childhood c-ALL patients and 136 infant controls. We found no difference in the frequency of NK1 and NK2 alleles, phenotypes or genotypes between the patients and controls, suggesting that this does not explain the role of the HLA-C locus in susceptibility to childhood c-ALL.
    • Lack of association between in vitro clonogenic growth of human cervical carcinoma and tumour stage, differentiation, patient age, host cell infiltration or patient survival.

      Davidson, Susan E; West, Catharine M L; Hunter, Robin D; Cancer Research Campaign Department of Experimental Radiation Oncology, Paterson Institute for Cancer Research, Manchester, UK. (1992-01-02)
      Biopsies from 117 patients with cervical carcinoma were studied using a clonogenic assay to assess in vitro growth. Successful colony growth was achieved in 84 tumours (72%) with a mean colony-forming efficiency (CFE), based on total viable nucleated cell counts, of 0.18 +/- 0.49% (+/- 1 standard deviation). There was a wide range of values, from 0.003-4.28%, with a coefficient of variation of 272%. The relationship between clinical features of cervical carcinoma and in vitro colony formation was investigated. No significant association was demonstrated between in vitro growth and either clinical stage (r = 0.02), tumour differentiation (r = -0.08) or patient age (r = -0.12). There was no significant difference in tumour grade between the group of tumours which failed to grow in culture and those which grew well (p = 0.70). In addition, there was no correlation between CFE and the degree of macrophage (r = 0.001), lymphocyte (r = 0.12), or granulocyte (r = 0.08) infiltration. There was no significant difference between CFEs of tumours from patients who had died and from those who were alive and well after a minimum of 2 years' follow-up after radiotherapy (p = 0.51). Ability to form colonies in agar was not associated with a worse prognosis (p = 0.49). Although CFE is an independent biological parameter, our results suggest that, for cervical carcinoma, it is not useful as a univariate prognostic factor.
    • Lack of binding of serum glycoprotein hormone alpha subunit to concanavalin A-Sepharose reflects increased branching of the oligosaccharide chains.

      Chapman, A J; Gallagher, John T; Beardwell, Colin G; Shalet, Stephen M; Paterson Laboratories and Radiotherapy Department, CHristie Hospital and Holt Radium Institute, Manchester M20 9BX (1984-10)
      The lectin-binding properties of serum alpha subunit were studied by lectin affinity chromatography. Normal individuals and most patients with pituitary tumours produced alpha subunit which bound specifically to Concanavalin A-Sepharose (Con A). Some patients with pituitary tumours produced both Con A-reactive alpha subunit and alpha subunit which did not bind to Con A. Concanavalin A-Sepharose-binding alpha subunit from all sources bound strongly to Ricinus communis agglutinin-Sepharose after treatment with neuraminidase. Serum alpha subunit from those patients with pituitary tumours, which did not bind to Con A, bound to wheat germ agglutinin-Sepharose, exhibiting both weakly binding and strongly binding forms. Serum alpha subunit from both patients and controls, which did bind to Con A, showed only weak affinity for wheat germ agglutinin-Sepharose. Neither the low affinity nor the high affinity of serum alpha subunit from any source for wheat germ agglutinin-Sepharose was affected by neuraminidase. These findings show that (a) the predominant pattern of glycosylation of serum alpha subunit from normal controls is a Con A-reactive, biantennate complex oligosaccharide and (b) that the structural alteration which results in serum alpha subunit which does not bind to Con A in some patients with pituitary tumours is not an absence of carbohydrate, rather the alpha subunit contains highly branched, either complex or hybrid oligosaccharides.
    • Lack of correlation between peripheral blood lymphokine-activated killer (LAK) cell function and clinical response in patients with advanced malignant melanoma receiving recombinant interleukin 2.

      Ghosh, Anna K; Dazzi, H; Thatcher, Nick; Moore, M; Cancer Research Campaign, Paterson Institute for Cancer Research, Christie Hospital, Manchester, UK. (1989-03-15)
      A phase-I/II study of recombinant interleukin 2 (rIL-2) was performed in 31 melanoma patients. The first dose of rIL-2 was given intrasplenically followed 4 hr later by an i.v. dose and 3 further i.v. doses on alternate days. Three courses of treatment were planned at 3-week intervals. The maximum tolerated single dose was 11 x 10(6) Cetus U/m2. Haematological and immunological data were available on 20 patients. Post-treatment response to rIL-2 therapy was evident from (i) a rapid depletion of peripheral blood lymphocytes (PBL) with a rebound at 4-7 days (2 times pre-treatment values); (ii) an increase in the number of IL-2 receptor-positive lymphocytes (4-15 times pre-treatment values); (iii) an increase in the number of "positive" patients with cytotoxic (anti-K562) peripheral blood mononuclear cells (PBMC) from 30% to 80%; (iv) amplified killing of K562 by positive patients in relation to pre-treatment values; and (v) the induction of PBMC cytotoxicity (in 45% of patients) against the NK-resistant, LAK-sensitive target, Mel I. Partial clinical responses to rIL-2 treatment were observed in 4 patients, but these were not reflected in the PBMC LAK activity or the other parameters examined.
    • The lack of correlation between proliferation (Ki-67, PCNA, LI, Tpot), p53 expression and radiosensitivity for head and neck cancers.

      Björk-Eriksson, Thomas; West, Catharine M L; Cvetskovska, E; Svensson, M; Karlsson, E; Magnusson, Bengt; Slevin, Nicholas J; Edström, S; Mercke, Claes; Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden. (1999-07)
      A study was made of the relationship between measurements of radiosensitivity versus proliferation and p53 status in head and neck cancers. Inherent tumour radiosensitivity was assessed as surviving fraction at 2 Gy (SF2) using a clonogenic soft agar assay (n = 77). The results were compared to data on proliferation obtained by both flow cytometry (labelling index (LI), the potential doubling time (Tpot) n = 55) and immunohistochemistry (Ki-67 and PCNA; n = 68), together with immunohistochemical p53 expression (n = 68). There were no overall significant differences in the median values of the various parameters analysed for the different sites within the head and neck region, disease stages, grades of tumour differentiation or nodal states. A subgroup analysis showed that oropharyngeal (n = 22) versus oral cavity (n = 35) tumours were more radiosensitive (P = 0.056) and had a higher Ki-67 index (P = 0.001). Node-positive tumours had higher LI (P = 0.021) and a trend towards lower Tpot (P = 0.067) values than node-negative ones. No correlations were seen between SF2 and any of the parameters studied. The long-standing dogma of an increased radiosensitivity of rapidly proliferating cells in contrast to slowly proliferating cells was not confirmed. The study shows that parallel measurements of different biological markers can be obtained for a large number of patients with head and neck cancers. The independence of the various parameters studied suggests that there may be potential for their combined use as prognostic factors for the outcome of radiotherapy.
    • Lack of correlation between residual radiation-induced DNA damage, in keratinocytes assayed directly from skin, and late radiotherapy reactions in breast cancer patients.

      Kiltie, Anne E; Barber, James B P; Swindell, Ric; Ryan, Anderson J; West, Catharine M L; Hendry, Jolyon H; Magee, Brian; CRC Section of Genome Damage and Repair, Christie Hospital NHS Trust, Manchester, United Kingdom. (1999-02-01)
      PURPOSE: To study the relationship between the severity of late reactions to radiotherapy in breast cancer patients, and the extent of residual radiation-induced DNA damage, using a rapid assay of keratinocytes obtained directly from skin biopsies. METHODS AND MATERIALS: A review was made of 32 patients with breast cancer, treated uniformly by radiotherapy between 1983 and 1988, following breast-conserving surgery. Their late radiotherapy reactions were scored (9-14 years post-radiotherapy) using a modified LENT SOMA scale, and a 5-mm buttock skin punch biopsy was obtained. Intact skin was irradiated at room temperature, and after allowing 24 h for repair, the tissue was disaggregated and the cells processed for pulsed field gel electrophoresis (PFGE). Residual DNA damage was expressed as the fraction of DNA released (FDR) following 150 Gy. RESULTS: Studies using flow cytometry on disaggregated breast skin showed that over 90% of the cells were keratinocytes. The PFGE assay was robust with low background FDRs in unirradiated skin samples (mean 3.2%) and a wide range of FDRs following irradiation from 11.5% to 26.6%. No correlation was found between the FDR at 150 Gy (FDR 150) and any of the late reaction scores or retrospective acute reaction scores. There was, however, a borderline significant correlation for family history and FDR 150 (p = 0.059). CONCLUSION: Rapid measurement of residual DNA damage in irradiated differentiated keratinocytes, the predominant cell population in skin biopsies, showed no correlation with the severity of symptomatic early or documented late reactions in a retrospectively studied group of 32 breast cancer patients.
    • Lack of correlation between stem-cell proliferation and radiation- or smoking-associated cancer risk.

      Little, M; Hendry, Jolyon H; Puskin, J; Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Rockville, Maryland (2016)
      A recent paper by Tomasetti and Vogelstein (Science 2015 347 78-81) suggested that the variation in natural cancer risk was largely explained by the total number of stem-cell divisions, and that most cancers arose by chance. They proposed an extra-risk score as way of distinguishing the effects of the stochastic, replicative component of cancer risk from other causative factors, specifically those due to the external environment and inherited mutations.
    • Lack of effect of immunotherapy with BCG and Corynebacterium parvum on hepatic drug hydroxylation in man.

      Wan, H H; Thatcher, Nick; Mullen, P W; Smith, G N; Wilkinson, Peter M; Christie Hospital and Holt Radium Institute, Manchester. (1979-04)
      Serial serum diphenylhydantoin and urinary 5-(p-hydroxphenyl)-5-phenylhydantoin concentrations were determined in 8 patients with malignant disease and 4 healthy volunteers on 2 separate occasions after an oral dose of diphenylhydantoin (500 mg). No significant difference was observed between metabolism before and 10 days after immunization with BCG or Corynebacterium parvum. Volunteers without intervening immunization similarly showed no difference.
    • Lack of late skin necrosis in man after high-dose irradiation using small field sizes: experiences of grid therapy.

      Shirato, H; Gupta, Nirmal K; Jordan, Thomas J; Hendry, Jolyon H; Department of Radiotherapy, Christie Hospital and Holt Radium Institute, Manchester, UK. (1990-11)
      Out of a total of 437 patients with superior vena caval syndrome or advanced malignancy, given single-dose grid radiotherapy, four survived to 7 years. The dose to the skin under each of the 77 holes in the grid was approximately 58 Gy. The lack of skin necrosis in the total of 308 skin circles of 1 cm diameter among these survivors, compared with known necrosis rates in larger irradiated areas, implies that there is a marked field-size effect for late necrosis in small areas of irradiated skin.
    • Lack of Prognostic Effect of Carbonic Anhydrase-9, Hypoxia Inducible Factor-1α and Bcl-2 in 286 Patients with Early Squamous Cell Carcinoma of the Glottic Larynx Treated with Radiotherapy.

      Douglas, Catriona Mairi; Bernstein, Jonathan M; Ormston, V E; Hall, R C; Merve, Ashriwad; Swindell, Ric; Valentine, Helen R; Slevin, Nicholas J; West, Catharine M L; Homer, J; et al. (2012-07-25)
      AIMS: To evaluate the prognostic significance of potential tumour markers of hypoxia and apoptosis in early squamous cell carcinoma of the glottic larynx managed with radiotherapy. MATERIALS AND METHODS: In total, 382 patients with T1 and T2 squamous cell carcinoma of the glottic larynx (vocal cords) received radical radiotherapy (50-55 Gy, in 16 fractions in 98% of cases). Pre-treatment haemoglobin was available for 328 patients; biopsy samples were available for 286. Immunohistochemistry was carried out for carbonic anhydrase-9 (CA-9), hypoxia inducible factor-1α (HIF-1α) and Bcl-2. RESULTS: At 5 years, locoregional control was achieved in 88.2%, cancer-specific survival in 95.0% and overall survival in 78.7%. Adverse prognostic factors for locoregional tumour recurrence were pre-treatment haemoglobin <13.0 g/dl (P = 0.035, Log rank test; sensitivity 0.28, specificity 0.84) and stage T2 rather than T1 (P = 0.002). The effect of haemoglobin level on locoregional control was not significant when stratified by the median of 14.2 g/dl (P = 0.43) or as a continuous variable (P = 0.59). High CA-9 (P = 0.11), HIF-1α (P = 0.67) and Bcl-2 (P = 0.77) expression had no prognostic significance. CONCLUSIONS: High CA-9, HIF-1α and Bcl-2 do not add to the prognostic significance of tumour stage and lower haemoglobin in predicting failure of local control in early glottic larynx squamous cell carcinoma managed with radiotherapy. The effect of haemoglobin was not strong enough to be useful as a prognostic biomarker.
    • Lack of response of bone marrow, in vitro, to growth factors in congenital neutropenia.

      Chang, James; Craft, A W; Reid, M M; Coutinho, Lucia H; Dexter, T Michael; Department of Haematology, Christie Hospital, Manchester, United Kingdom. (1990-10)
      Severe congenital neutropenia has a poor outlook. In vitro clonogenic assays using recombinant growth factors may improve understanding of the underlying pathogenetic mechanisms and identify those in whom growth factors might be clinically useful. Marrow from a boy with congenital neutropenia was cultured with a variety of recombinant growth factors. The results show that the neutropenia did not result from a lack of myeloid progenitors but that these progenitors could not produce mature neutrophils. Bone marrow transplantation is being considered as the most likely approach to correct neutropenia.
    • Lactate dehydrogenase as a selection criterion for ipilimumab treatment in metastatic melanoma.

      Kelderman, S; Heemskerk, B; van Tinteren, H; van den Brom, R; Hospers, G; van den Eertwegh, A; Kapiteijn, E; de Groot, J; Soetekouw, P; Jansen, R; et al. (2014-05)
      Ipilimumab, a cytotoxic T lymphocyte-associated antigen-4 blocking antibody, has improved overall survival (OS) in metastatic melanoma in phase III trials. However, about 80 % of patients fail to respond, and no predictive markers for benefit from therapy have been identified. We analysed a 'real world' population of patients treated with ipilimumab to identify markers for treatment benefit.
    • Landmark survival analysis and impact of anatomic origin in prospective clinical trials of biliary tract cancer

      McNamara, Mairead G; Lopes, A.; Wasan, H.; Malka, D.; Goldstein, D.; Shannon, J.; Okusaka, T.; Knox, J. J.; Wagner, A. D.; Andre, T.; et al. (2020)
      BACKGROUND: Inclusion of all patients with advanced biliary tract cancer (aBTC), irrespective of anatomic location, in prospective trials, is debated. Survival rates from landmark analysis offer more relevant information once patients have survived for some time. AIM: assess survival impact of BTC anatomic site origin and landmark survival (LS). PATIENTS AND METHODS: Patients enrolled into prospective first-line aBTC clinical trials were included. OS was analysed using Cox-proportional-hazard-regression; LS and 95% confidence intervals (CIs) were calculated. RESULTS: Overall: 1333 patients included (Jan 97-Dec 15); median age 63-years (range 23-85); 46%-male; 84%-ECOG-PS0/1; 25%-locally-advanced (LA), 72%-metastatic, 3%-not reported (NR); gallbladder-(GBC): 385 (29%), cholangiocarcinoma not-specified-(CCA-NS): 363 (27%), extrahepatic-(EHC): 247 (19%), intrahepatic-(IHC): 209 (16%), ampulla: 53 (4%), 76 (6%) NR. Treatment was mono-chemotherapy: 310-(23%), cisplatin/gemcitabine: 482-(36%), other combination: 520-(39%), NR: 21-(2%). Median OS: 10.2-months (95%-CI 9.6-10.9). All sites (treatment-adjusted) had decreased risk of death vs GBC: EHC-(P<.001), IHC-(P<.002), CCA-NS-(P<.003), ampulla-(P=.003). This reduced risk vs GBC was maintained in those receiving cisplatin/gemcitabine in EHC-(P<.001) and IHC-(P<.001), but not in CCA-NS-(P=.82) or ampulla-(P=.96). Probabilities of surviving an additional year given survival to 1, 2, 3, and 4 years post-trial registration were 37%, 45%, 61%, and 63% respectively. For patients who survived 1 year; those receiving combination therapy vs mono (P=.008) (acknowledging potential selection bias), and those with IHC and CCA-NS vs GBC had better LS (both P<.05). Metastatic stage vs LA was associated with shorter LS (P=.002). ECOG-PS and gender had no evidence of effect on LS (P.05
    • Landmarks in non-hormonal pharmacological therapies for castration-resistant prostate cancer.

      Clarke, Noel W; The Christie and Salford Royal Hospitals, Manchester, UK. (2012-10)
      The treatment of metastatic and castration-resistant prostate cancer (CRPC) has advanced considerably from the era where it was considered that the disease was resistant to chemotherapy. Cytotoxic chemotherapy involving docetaxel is now used routinely as a first-line therapy after failed first- and second-line androgen deprivation in advanced disease, improving quality of life and to a limited extent, survival in patients with advanced prostate cancer. The cytotoxic taxane, cabazitaxel has also become a second-line treatment option for patients with CRPC failing previous docetaxel therapy. Additionally, a broad range of agents are now available or under development including immune-based therapies (cellular therapies and vaccines), bone-targeting agents (anti-osteolytic and anti-tumour therapies) and molecular-based agents targeting cellular control mechanisms. Most of these remain experimental but on-going pharmacological development will inevitably provide urologists and urological oncologists with a broader range of therapeutic options for better cancer management in the future.
    • The landscape of systemic regimens used routinely in the neoadjuvant setting in the UK: the NEST national prospective multi-centre cohort study

      Copson, ER; Bannon, F; Coles, CE; Cutress, RI; Dave, RV; Gardiner, M; Grayson, M; Holcombe, C; Irshad, S; Irwin, G; et al. (2020)
    • Lanreotide depot/autogel before, during, and after peptide receptor radionuclide therapy in advanced neuroendocrine tumors: data from the PRELUDE study (*)

      Prasad, V; Srirajaskanthan, R; Toumpanakis, C; Grana, C; Baldari, S; Shah, T; Lamarca, Angela; Courbon, F; Scheidhauer, K; Baudin, E; et al. (2019)
    • Laparoscopic colorectal surgery outcomes improved after national training program (LAPCO) for specialists in England

      Hanna, G. B.; Mackenzie, H.; Miskovic, D.; Ni, M.; Wyles, S.; Aylin, P.; Parvaiz, A.; Cecil, T.; Gudgeon, A.; Griffith, J.; et al. (2020)
      Objective: 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. Summery background data: Lapco provided competency-based supervised clinical training for specialist colorectal surgeons in England. Methods: 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. Results: 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<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. Conclusions: 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.