Laparoscopic Colorectal Resection after Endoscopic Stent Insertion in Cases of Malignant Colorectal Obstruction: the Experience of a Single Center

PURPOSE: Laparoscopic surgery has been considered to be contraindicated for obstructive colorectal cancer. However, endoscopic stent insertion for obstructive colorectal cancer has recently allowed elective laparoscopic surgery. The aim of this study is to evaluate the feasibility and the short-term clinical outcomes of laparoscopic surgery following endoscopic stent insertion for management of malignant colorectal obstruction at a single center. METHODS: The medical records of patients who had undergone endoscopic stent insertion for colorectal cancer obstruction, followed by laparoscopic colorectal resections, from August 2004 to August 2008 were reviewed. To evaluate the surgical and clinical outcomes, we analyzed the clinical and pathologic data. RESULTS: Thirty-six endoscopic stent insertions were successfully performed during the study period. Of those 36, the 28 treated by laparoscopic surgery were enrolled in this study. The mean interval between stent insertion and surgery was 7.4+/-2.3 days. Two cases were converted to open surgery. The mean operative time was 185.5+/-53.1 min, and the mean blood loss was 77.0+/-72.9 mL. Flatus was passed on the mean 2nd postoperative day, and patients started to eat on the mean 4th postoperative day. The mean postoperative hospital stay was 11.2+/-4.4 days. Anastomosis leakages occurred in two cases and were treated by a secondary operation with a transient ileostomy. There were morbidities in five cases, but no mortalities. CONCLUSION: A combined endoscopic stent insertion and laparoscopic surgery is an effective and safe, minimally invasive operation for malignant colorectal obstruction.

Short-term Clinico-pathological Outcomes of a Laparoscopic Transverse Colectomy for Transverse Colon Cancer

PURPOSE: The COST study trial has demonstrated oncological safety by using laparoscopy for colon cancer. However, in a prior trial, the transverse colon was excluded. Therefore, it has not been determined whether laparoscopy can be used in the setting of transverse colon cancer. Moreover, a transverse colectomy for transverse colon cancer is controversial. This study evaluated the peri-operative and short-term oncological outcomes of a laparoscopic transverse colectomy. METHODS: A retrospective review of patients with colorectal cancer treated using laparoscopy from August 2004 to August 2007 was conducted. Peri-operative and short-term oncological outcomes were compared between an extended right or left colectomy and a transverse colectomy. RESULTS: Of 234 patients, 26 patients underwent laparoscopic surgery for transverse colon cancer. Extended right & left colectom were performed in 20 cases, and a transverse colectomy was performed in 6 cases. There were no significant differences between the two groups in terms of age, gender, BMI, blood loss, time to pass flatus, start of diet, hospital stay, tumor size, number of lymph nodes, and radial margin. The distal and the proximal resection margins of an extended Rt. or Lt. colectomy were longer than those of a transverse colectomy. One transverse colectomy was converted to open surgery because of a T4 lesion of transverse colon cancer. There were no differences between the two groups in terms of morbidity and mortality. CONCLUSIONS: The results of this study show that a laparoscopic transverse colectomy has acceptable peri-operative and short-term oncological outcomes compared to an extended right and left colectomy. However, further investigations are needed to establish the long-term oncological safety of laparoscopic surgery, including transverse colectomy, for transverse colon cancer.