Short-Term Outcome of Curative One-Stage Laparoscopic Resection for Obstructive Left-Sided Colon Cancers Followed by Stent Insertion: Comparative Study with Non-Obstructive Left-Sided Colon Cancers

PURPOSE: Laparoscopic surgery has been considered to be contraindicated for treating malignant colorectal obstruction. Stent insertion for obstructive colorectal cancer has recently allowed laparoscopic surgery to be performed by means of preoperative bowel decompression and bowel preparation. The aim of this study is to evaluate the safety and the feasibility of a one-stage laparoscopic resection for obstructive left-sided colon cancer after stent insertion by comparing the results to those for non-obstructive left-sided colon cancer. METHODS: Between May 2006 and January 2009, a laparoscopic colorectal operation was performed on 18 consecutive patients with obstructive left-sided colon cancer after placement of a self-expandable stent by one colorectal surgeon, and the results were compared retrospectively to those for 43 patients with non-obstructive left-sided colon cancer who had undergone a laparoscopic procedure with the same surgeon. The collected data were the clinicopathologic characteristics, the perioperative complications, the oncologic outcomes, the postoperative recovery results, and the survival rate. RESULTS: The obstructive left-sided colon cancer group had significant benefits in retrieved lymph nodes (18.8+/-5.3 vs. 14.0+/-8.7, P=0.036), and distal resection margin (5.5+/-3.0 cm vs. 3.6+/-2.4 cm, P=0.011). There were no significant differences in other clinicopathological characteristics and oncologic outcomes, including the overall 3-yr survival rate, between the two groups. CONCLUSION: Preoperative stent decompression followed by a laparoscopic colorectal resection is a safe and feasible option for treating obstructive left-sided colon cancer. A further large-scale prospective study should be performed to evaluate the long-term outcome of a one-stage laparoscopic resection using stent insertion in cases of obstructive left-sided colon cancer.

Laparoscopic Colorectal Resection for Aged Patients

PURPOSE: The purpose of this study is to assess the periopertive morbidity and mortality rates in relation to the principal variables in aged patients who undergo laparoscopic colorectal resection. METHODS: From March 2001 to March 2006, the prospective laparoscopic colorectal resection database was used to identify 233 patients. Among them, 132 were 70 years of age or older and they were classified as the aged group. 101 were younger than 70 years of age and they were classified as the younger group. RESULTS: Comorbidity was more common in the aged group than in the younger group (67.4% and 53.5%, respectively) (P=0.030). There were higher ASA scores in the aged group (I: 2.3% II: 68.2% III: 29.5%) than in the younger group (I: 27.7% II: 56.4% III: 15.8%) (P<0.0001). There was a higher postoperative complication rate for the aged group than for the younger group (25.0% and 8.9%, respectively) (P=0.002). Only one case of mortality (0.8%) was found in the aged group. The period of the postoperative hospital stay was longer for the aged group than that for the younger group (21.9+/-3/416.3 days and 16.3+/-3/48.1days, respectively) (P= 0.002). For the aged group, univariate analysis revealed that the operative procedure, disease, the T stage and the operation time were significant variables for the postoperative complications, and multivariate analysis identified the operation time as an independent variable faor the postoperative complications. CONCLUSION: More prudent care is needed to prevent postoperative complications for the aged patients who undergo laparoscopic colorectal resection, and particularly for those who can be expected to have a longer operation time.

Laparoscopic Resection after Stenting in Obstructive Colorectal Cancers

PURPOSE: Laparoscopic surgery has been considered to be contraindicated for treating malignant colorectal obstruction. Stent insertion for obstructive colorectal cancer has recently allowed laparoscopic surgery to be performed by means of preoperative decompression and bowel preparation. This study is designed to evaluate the feasibility of performing laparoscopic surgery followed by stent insertion for treating malignant colorectal obstruction. Further, we wanted to compare the extent of surgery and the outcomes between laparoscopic and conventional colorectal surgery. METHODS: We reviewed nineteen cases of colorectal resections that were treated with stent insertion for malignant obstruction from Feb. 2003 and Aug. 2005. The results of stent insertion, the TNM stage, the extent of surgery and the postoperative courses were compared between the laparoscopic (n=9) and conventional groups (n=10). RESULTS: The stents were successfully inserted and the obstruction was relieved in all the cases. One case of laparoscopic approach was converted to open surgery due to massive tumor invasion to the adjacent organ. In terms of the extent of surgery, there were no significant differences in the tumor size (4.6 vs. 5.0 cm, respectively), the length of the specimen (24.6 vs. 25.3 cm, respectively), the number of retrieved lymph nodes (16.3 vs. 23.1, respectively), the proximal resection margin (12.1 vs. 14.1 cm, respectively), and the distal resection margin (5.4 vs. 5.0 cm, respectively) between the two groups. Also, there were no differences in the first feeding (3.8 vs. 4.4 days) and the postoperative hospital stay (10.0 vs. 11.7 days) between the two groups. CONCLUSION: The laparoscopic approach followed by preoperative stent insertion is a feasible option for treating obstructive colorectal cancer. There were no differences in the extent of surgery and the postoperative outcomes between the laparoscopic and conventional groups. The endoluminal-laparoscopic approach can be an effective strategy for treating obstructive colorectal cancer with its synergic advantage of being minimally invasive.