Short-term Oncologic Outcome of Curative Resection for Obstructive Colorectal Cancer Followed by Stent Insertion: Comparative Study with Non-abstructive Colorectal Cancer

PURPOSE: Recently, a self-expandable metallic stent has allowed an elective single-stage resection avoiding the risk of emergency operation and stoma formation in patients with obstructive colorectal cancer (CRC). But, forceful expansion of stent may increase the possibility of tumor cell exfoliation and dissemination through bowel lumen, lymphatic and blood vessels. Aim of study is to evaluate the short-term outcome of curative resection for obstructive colorectal cancer followed by stent in terms of oncologic safety. METHODS: Twenty-seven patients who underwent curative resection for obstructive CRC followed by stent insertion were included in 'stent group' and control group included 87 patients who underwent surgery for non-obstructive CRC. The clinicopathologic characteristics and prognosis were compared between two groups. RESULTS: There was no significant difference in clinicopathologic characteristics between two groups. No difference was found in postoperative complications between two groups. Overall survival rate of two groups showed no statistically significant differences (P=0.1254). Stage-matched survival rates (stage II & III) were also showed no differences between two groups. CONCLUSION: Stent insertion itself does not compromise the survival of patients with obstructive CRC. Oncologic safety of stent insertion for obstructive CRC is acceptable. A further large-scaled prospective study and long-term follow-up is necessary to evaluate the oncologic safety of stent insertion in obstructive CRC.

The Early Experience of Laparoscopic Sigmoid Colon and Rectal Cancer Resection

PURPOSE: The aim of this study is to assess the pathologic surgical outcome and short-term outcome of a laparoscopic colorectal resection at an early time on the learning curve in comparison with open surgery. METHODS: Retrospectively collected data were obtained on 49 patients who underrent a laparoscopic sigmoid colon and rectal cancer resection between May 2001 and January 2006. The compared factors were the clinicopathologic characteristics, the operation time, the postoperative recovery, and complications. RESULTS: There were no significant differences in age, sex, TNM stage, and tumor size between the laparoscopic and open-surgery groups. The operation time was significantly longer in the laparoscopic group (291.4 vs. 201.9 min P < 0.001). In the view point of postoperative recovery, the laparoscopic group showed a significant advantage in the passage of flatus. There were no significant differences in harvested LNs, proximal margin, and distal margin between the two groups. The complication rate was not significantly different, but anastomotic leakage was higher in the laparoscopic group (16.7% vs. 2%, P=0.02). CONCLUSIONS: There were no significant differences in harvested LNs, proximal margin, and distal margin between the two groups, but anastomotic leakage was higher in the laparoscopic group.

Current Status of Laparoscopic Colectomy for Colon Cancer

Although laparoscopic colon resection is a widely accepted treatment for benign colon disease, many questions have been raised about its value in management of colorectal cancer. The short-term benefits of this operation, such as decreased incidence of pulmonary complications, faster return of the bowel function, decreased narcotic requirements, shortened hospital stay, and faster recovery time, are now well established. However, there are many controversies for this method as a treatment of cancer. The main issues are adequacy of oncologic resection, recurrence rates and patterns, and long-term survival. Considering the results so far reported, laparoscopic colectomy seems to be feasible and safe. Modest benefits in the quality of life are observed. Same oncologic resection can be performed laparoscopically with no adverse influence on the recurrence rate. At least, equivalent survival is obtained by laparoscopic colectomy. Even the early results of laparoscopic colectomy for cancer are encouraging, the fate of this procedure rests with the long term analysis of number of trials currently underway.

Comparison of Long-term Survival for Laparoscopic-assisted Surgery and Open Surgery for Right Colon Cancer: A Case-Control Study

PURPOSE: The aim of this study was to compare the long-term oncologic outcomes of laparoscopy assisted and open surgery for patients with right colon cancer. METHODS: From June 1996 to May 2000, 35 patients underwent curative surgery with a laparoscopic-assisted right hemicolectomy (LAC), and from among the patients who had curative open surgery, 35 patients with clinicopathologic characteristics comparable to those of the LAC group were selected and matched as a control group (OC). A comparative analysis of long-term survival and patterns of recurrence between these two groups was done. RESULTS: There were no statistical differences in demographic, laboratory and pathologic characteristics between the two groups. The mean follow-up period was 54.5 months. The overall five-year survival was 82.9% in the LAC group and 68.6% in the OC group, but was not statistically significant (P=0.17). Interestingly, the five-year survival of patients with TNM stage III tumors was significantly higher in the LAC group (84.2%) than in the OC group (52.6%) (P=0.04). There were no port-site recurrences or operative deaths. CONCLUSIONS: The long-term oncologic outcomes of laparoscopic surgery for right-sided colon cancer were similar to those of open surgery. Interestingly, laparoscopic surgery for stage III tumors showed better survival than open surgery. However, a more large-scaled randomized study will be needed to clarify the oncologic safety of laparoscopic surgery for colon cancer.