World Journal of Surgery

, Volume 32, Issue 10, pp 2275–2280 | Cite as

Feasibility of Single-Stage Laparoscopic Resection After Placement of a Self-Expandable Metallic Stent for Obstructive Left Colorectal Cancer

  • Tae-Sung Chung
  • Seok-Byung LimEmail author
  • Dae Kyung Sohn
  • Chang Won Hong
  • Kyung Su Han
  • Hyo Seong Choi
  • Seung-Yong Jeong



The present study investigated the feasibility of a single-stage operation consisting of self-expandable metallic stent (SEMS) placement followed by laparoscopic surgery for obstructive left colorectal cancer.


From July 2002 to March 2007, 17 consecutive patients with primary obstructive left colorectal cancer underwent SEMS placement followed by laparoscopic surgery. Data were collected retrospectively regarding clinicopathological findings, SEMS placement, operative procedures, and perioperative outcomes. Technical success was defined as successful stent deployment across the obstructive lesion, and clinical success as the possibility of performing a single-stage operation without creating a stoma.


In the laparoscopic group, the technical success rate was 100% (17/17) and there was no morbidity associated with SEMS placement. The median interval to laparoscopic surgery was 7 (range, 2–11) days, and the procedures included 11 anterior resections, 3 left hemicolectomies, 2 Hartmann’s procedures, and 1 subtotal colectomy. All procedures were completed laparoscopically without conversion to open surgery. The median operating time was 178 (range, 93–377) minutes, and the median estimated blood loss was 100 (range, 50–400) ml with no cases requiring intraoperative transfusions. The clinical success rate was 82.4% (14/17), and there was no surgical morbidity other than two patients in whom chyloperitoneum and ileus were controlled by using conservative management. The median postoperative hospital stay was 9 (range, 7–49) days.


A single-stage operation consisting of SEMS placement followed by laparoscopic surgery seems to be a feasible and safe treatment option for obstructive left colorectal cancer.


Laparoscopic Surgery Stent Placement Subtotal Colectomy Clinical Success Rate Obstructive Lesion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Philips RK, Hittinger R, Fry JS et al (1985) Malignant large bowel obstruction. Br J Surg 72:296–302CrossRefGoogle Scholar
  2. 2.
    Deans GT, Krukowski ZH, Irwin ST (1994) Malignant obstruction of the left colon. Br J Surg 81:1270–1276PubMedCrossRefGoogle Scholar
  3. 3.
    Irvin GL, Horsley JS, Caruana JA (1984) The morbidity and mortality of emergent operations for colorectal disease. Ann Surg 199:598–603PubMedCrossRefGoogle Scholar
  4. 4.
    Leitman IM, Sullivan JD, Brams D et al (1992) Multivariate analysis of the morbidity and mortality from initial surgical management of obstructing carcinoma of the colon. Surg Gynecol Obstet 174:513–518PubMedGoogle Scholar
  5. 5.
    Mulcahy HE, Skelly MM, Hussain A et al (1996) Long-term outcome following curative surgery for malignant large bowel obstruction. Br J Surg 83:46–50PubMedCrossRefGoogle Scholar
  6. 6.
    Tejero E, Mainar A, Fernandez L et al (1994) New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum 37:1158–1159PubMedCrossRefGoogle Scholar
  7. 7.
    Mainer A, De Gregorio MA, Tejero E et al (1999) Acute colorectal obstruction with self expandable metallic stents before scheduled surgery: results of a multicenter study. Radiology 210:65–69Google Scholar
  8. 8.
    Martinez-Santos C, Lobato RF, Fradejas JM et al (2002) Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum 45:401–406PubMedCrossRefGoogle Scholar
  9. 9.
    Khot UP, Lang AW, Murali K et al (2002) Systematic review of the efficacy and safety of colorectal stents. Br J Surg 89:1096–1102PubMedCrossRefGoogle Scholar
  10. 10.
    Saida Y, Sumiyama Y, Nagao J et al (2003) Long-term prognosis of preoperative “bridge to surgery” expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation. Dis Colon Rectum 46:44–49Google Scholar
  11. 11.
    Sebastian S, Johmston S, Geoghegan T et al (2004) Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 99:2051–2057PubMedCrossRefGoogle Scholar
  12. 12.
    Stefanidis D, Brown K, Nazario H et al (2005) Safety and efficacy of metallic stents in the management of colorectal obstruction. JSLS 9:454–459PubMedGoogle Scholar
  13. 13.
    Parker MC (2006) Colorectal stenting. Br J Surg 93:907–908PubMedCrossRefGoogle Scholar
  14. 14.
    Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726PubMedCrossRefGoogle Scholar
  15. 15.
    Lacy AM, Garcia-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 29:2224–2229CrossRefGoogle Scholar
  16. 16.
    The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRefGoogle Scholar
  17. 17.
    The Colon Cancer Laparoscopicor Open Resection Study Group (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484CrossRefGoogle Scholar
  18. 18.
    Balague C, Targarona EM, Sainz S et al (2004) Minimally invasive treatment for obstructive tumors of the left colon: endoluminal self-expanding metal stent and laparoscopic colectomy. Preliminary results. Dig Surg 21:282–286PubMedCrossRefGoogle Scholar
  19. 19.
    Law WL, Choi HK, Lee YM et al (2004) Laparoscopic colectomy for obstructing sigmoid cancer with prior insertion of an expandable metallic stent. Surg Laparosc Endosc Percutan Tech 14:29–32PubMedCrossRefGoogle Scholar
  20. 20.
    Morino M, Bertello A, Garbarini A et al (2002) Malignant colonic obstruction managed by endoscopic stent decompression followed by laparoscopic resections. Surg Endosc 16:1483–1487PubMedCrossRefGoogle Scholar
  21. 21.
    Dulucq JL, Wintringer P, Beyssac R et al (2006) One-stage laparoscopic colorectal resection after placement of self-expanding metallic stents for colorectal obstruction. Dig Dis Sci 51:2365–2371PubMedCrossRefGoogle Scholar
  22. 22.
    Mochizuki H, Nakamura E, Hase K et al (1993) The advantage of primary resection and anastomosis with intraoperative bowel irrigation for obstructing left-sided colorectal carcinoma. Surg Today 23:771–776PubMedCrossRefGoogle Scholar
  23. 23.
    Stephenson BM, Shandall AA, Farouk R et al (1990) Malignant left-sided large bowel obstruction managed by subtotal/total colectomy. Br J Surg 77:1098–1102PubMedCrossRefGoogle Scholar
  24. 24.
    Tejero E, Mainar A, Fernandez L et al (1995) New procedure for relief of malignant obstruction of the left colon. Br J Surg 82:34–35PubMedCrossRefGoogle Scholar
  25. 25.
    Chung CC, Kwok SP, Kwong KH et al (1997) Technique of laparoscopically assisted on-table colonic irrigation. Br J Surg 84:384PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  • Tae-Sung Chung
    • 1
    • 2
  • Seok-Byung Lim
    • 1
    • 3
    Email author
  • Dae Kyung Sohn
    • 1
  • Chang Won Hong
    • 4
  • Kyung Su Han
    • 4
  • Hyo Seong Choi
    • 1
  • Seung-Yong Jeong
    • 1
  1. 1.Center for Colorectal CancerResearch Institute & Hospital, National Cancer CenterGyeonggi-doKorea
  2. 2.Department of SurgeryHaNam SongDo HospitalGyeonggi-doKorea
  3. 3.Department of SurgeryUniversity of Ulsan College of Medicine and Asan Medical CenterSeoulKorea
  4. 4.Center for Cancer Prevention & DetectionResearch Institute & Hospital, National Cancer CenterGyeonggi-doKorea

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