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Indian Journal of Surgical Oncology

, Volume 9, Issue 4, pp 488–494 | Cite as

Clinical Utility of Staging Laparoscopy for Advanced Obstructing Rectal Adenocarcinoma: Emerging Tool

  • Avanish SaklaniEmail author
  • P. Sugoor
  • A. Chaturvedi
  • R. Bhamre
  • S. Jatal
  • V. Ostwal
  • R. Engineer
Original Article
  • 55 Downloads

Abstract

The multimodal treatment for advanced rectal adenocarcinoma mandates accurate preoperative staging with contrast-enhanced computed tomography (CECT) of the thorax, abdomen, and pelvis, and magnetic resonance imaging (MRI) of the pelvis. Unlike gastric cancer, the role of staging laparoscopy (SL) in advanced colorectal cancer has not been evaluated. This study aims to evaluate the clinical value of SL in treatment decision-making for advanced rectal cancer (RC) with near or complete obstructing tumors. Observational review of colorectal database at Tata Memorial Hospital from January 2013 to December 2016 identified 562 patients diagnosed and treated for advanced RC. Of the 562 cases, 48.7% (274) were clinically and radiologically diagnosed of near or complete obstructing advanced RC. Medical records of 34% (94/274) who underwent SL with diversion stoma (DS) were analyzed. In the absence of ascites, extensive peritoneal deposits, and unresectable liver metastases on SL, a curative treatment was offered, which entailed neoadjuvant chemoradiation (NACTRT), whereas the cohort of patients with extensive peritoneal disease received palliative therapy. Of the 94 patients with advanced RC, conventional imaging studies staged 73.5% (69/94) cohort as non-metastatic locally advanced and 26.5% (25/94) had potentially resectable metastatic RC. Pre-therapeutic SL upstaged the disease by 26% (18/69) and 8% (2/25) in locally advanced and potentially resectable metastatic RC cohorts, respectively. Treatment decision changed in 21.2% (20/94) of the patients, and midline laparotomy was thus avoided. In our observational study, SL was found to be a safe and effective staging modality in RC; it detected occult peritoneal disease and prevented midline laparotomy in 21.2% of the cohort, which was of value to determine treatment strategy in patients with advanced RC before initiating NACTRT. SL and laparoscopic-assisted de-functioning stoma were associated with minimal morbidity and led to early initiation of NACTRT.

Keywords

Rectal cancer Staging laparoscopy Peritoneal deposits Neoadjuvant chemoradiation Diversion stoma 

Notes

Compliance with Ethical Standards

Data of this study were collected in the course of common clinical practice and, accordingly, the signed informed consent was obtained from each patient for any surgical and clinical procedure. The study protocol conforms to the ethical guidelines of the “World Medical Association Declaration of Helsinki—Ethical Principles for Medical Research Involving Human Subjects” adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964, as revised in Tokyo 2004. No approval of the institutional review committee was needed.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© Indian Association of Surgical Oncology 2018

Authors and Affiliations

  • Avanish Saklani
    • 1
    Email author
  • P. Sugoor
    • 1
  • A. Chaturvedi
    • 1
  • R. Bhamre
    • 1
  • S. Jatal
    • 1
  • V. Ostwal
    • 1
    • 2
  • R. Engineer
    • 1
  1. 1.Department of Gastrointestinal Surgery and Colorectal Surgical OncologyTata Memorial HospitalMumbaiIndia
  2. 2.Department of Medical OncologyTata Memorial CentreMumbaiIndia

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