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

ABSTRACT

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.