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Comparison of One-Stage Managements of Obstructing Left-Sided Colon and Rectal Cancer: Stent-Laparoscopic Approach vs. Intraoperative Colonic Lavage

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Journal of Gastrointestinal Surgery

Abstract

Purpose

We evaluated the operative outcomes of laparoscopic surgery following self-expandable metallic stent compared to one-stage emergency surgical treatment.

Methods

From April 1996 to October 2007, 95 consecutive patients with left-sided malignant colorectal obstruction were enrolled. Twenty-five patients were assigned to the preoperative stenting and elective laparoscopic surgical treatment group (SLAP) and 70 to the emergency open surgery with intraoperative colon lavage group (OLAV).

Results

Among the 25 patients in the SLAP group, a primary anastomosis was possible in all patients and a diverting stoma was needed in one patient. The operative time was shorter in the SLAP group (198.53 vs. 262.17 min, P = 0.002). Tumor size, number of retrieved lymph nodes, and pathological stage were similar in both groups. The rate of anastomotic failure was similar and postoperative complications occurred less in the SLAP group (5.9% vs. 31.4%, P = 0.034). The passage of flatus and oral intake were resumed earlier in the SLAP group (2.88 vs. 3.68 days, P = 0.046 and 5.18 vs. 6.65 days, P < 0.001, respectively). The postoperative hospital stay was shorter in the SLAP group (10 vs. 15.4 days, P = 0.013).

Conclusions

In patients with left-sided malignant colon and rectal obstruction, laparoscopic surgery after SEMS could be safely performed with successful early postoperative outcomes.

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References

  1. Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon. Br J Surg 1994;81:1270–1276. doi:10.1002/bjs.1800810905.

    Article  PubMed  CAS  Google Scholar 

  2. Naraynsingh V, Rampaul R, Maharaj A, Kuruvilla T, Ramcharan K, Pouchet B. Prospective study of primary anastomosis without colonic lavage for patients with an obstructed left colon. Br J Surg 1999;86:1341–1343. doi:10.1046/j.1365-2168.1999.01230.x.

    Article  PubMed  CAS  Google Scholar 

  3. Torralba JA, Robles R, Parrilla P, Lujan JA, Liron R, Pinero A, et al. Subtotal colectomy vs. intraoperative colonic irrigation in the management of obstructed left colon carcinoma. Dis Colon Rectum 1998;41:18–22. doi:10.1007/BF02236890.

    Article  PubMed  CAS  Google Scholar 

  4. Forloni B, Reduzzi R, Paludetti A, Colpani L, Cavallari G, Frosali D. Intraoperative colonic lavage in emergency surgical treatment of left-sided colonic obstruction. Dis Colon Rectum 1998;41:23–27. doi:10.1007/BF02236891.

    Article  PubMed  CAS  Google Scholar 

  5. Hsu TC. One-stage resection and anastomosis for acute obstruction of the left colon. Dis Colon Rectum 1998;41:28–32. doi:10.1007/BF02236892.

    Article  PubMed  CAS  Google Scholar 

  6. Leitman IM, Sullivan JD, Brams D, DeCosse JJ. Multivariate analysis of morbidity and mortality from the initial surgical management of obstructing carcinoma of the colon. Surg Gynecol Obstet 1992;174:513–518.

    PubMed  CAS  Google Scholar 

  7. Dohmoto M. New method—endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endoscopia Digestiva 1991;3:1507–15012.

    Google Scholar 

  8. Itabashi M, Hamano K, Kameoka S, Asahina K. Self-expanding stainless steel stent application in rectosigmoid stricture. Dis Colon Rectum 1993;36:508–511. doi:10.1007/BF02050019.

    Article  PubMed  CAS  Google Scholar 

  9. Cwikiel W, Andre’n-Sandberg A. Malignant stricture with colovesical fistula: stent insertion in the colon. Radiology 1993;186:563–564.

    PubMed  CAS  Google Scholar 

  10. Turégano-Fuentes F, Echenagusia-Belda A, Simó-Muerza G, Camuñez F, Muñoz-Jimenez F, Del Valle Hernandez E, et al. Transanal self-expanding metal stents as an alternative to palliative colostomy in selected patients with malignant obstruction of the left colon. Br J Surg 1998;85:232–235. doi:10.1046/j.1365-2168.1998.00565.x.

    Article  PubMed  Google Scholar 

  11. De Gregorio MA, Mainar A, Tejero E, Tobío R, Alfonso E, Pinto I, et al. Acute colorectal obstruction: stent placement for palliative treatment. Results of a multicenter study. Radiology 1998;209:117–120.

    PubMed  Google Scholar 

  12. Tejero E, Mainar A, Frnández L, Tobío R, De Gregorio MA. New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum 1994;37:1158–1159. doi:10.1007/BF02049822.

    Article  PubMed  CAS  Google Scholar 

  13. Tobaruela E, Camuñas J, Enriquez-Navascúes JM, Díez M, Ratia T, Martín A, et al. Medical factors in the morbidity and mortality associated with emergency colorectal cancer surgery. Rev Esp Enferm Dig 1997;89:13–22.

    PubMed  CAS  Google Scholar 

  14. Biondo S, Pares D, Frago R, Martí-Ragué J, Kreisler E, De Oca J, et al. Large bowel obstruction: predictive factors for postoperative mortality. Dis Colon Rectum 2004;47:1889–1897. doi:10.1007/s10350-004-0688-7.

    Article  PubMed  Google Scholar 

  15. Stoianov KH, Karashmalukov A, Iuliianov A, Rachkov I, Vǔlchev D. An analysis of postoperative mortality in patients with large intestine occlusive ileus due to tumor origin. Khirurgiia (Sofiia) 1998;51:17–19.

    Google Scholar 

  16. Hennekinne-Mucci S, Tuech JJ, Bréhant O, Lermite E, Bergamaschi R, Pessaux P, et al. Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma. Int J Colorectal Dis 2006;21:538–541. doi:10.1007/s00384-005-0048-7.

    Article  PubMed  Google Scholar 

  17. Khot UP, Wenk Lang A, Murali K, Parker MC. Systematic review of the efficacy and safety of colorectal stents. Br J Surg 2002;89:1096–1102. doi:10.1046/j.1365-2168.2002.02148.x.

    Article  PubMed  CAS  Google Scholar 

  18. Balagué C, Targarona EM, Sainz S, Montero O, Bendahat G, Kobus C, et al. Minimally invasive treatment for obstructive tumors of the left colon: endoluminal self-expanding metal stent and laparoscopic colectomy: preliminary results. Dig Surg 2004;21:282–286. doi:10.1159/000080202.

    Article  PubMed  Google Scholar 

  19. Morino M, Bertello A, Garbarini A, Rozzio G, Repici A. Malignant colonic obstruction managed by endoscopic stent decompression followed by laparoscopic resections. Surg Endosc 2002;16:1483–1487. doi:10.1007/s00464-001-9182-7.

    Article  PubMed  CAS  Google Scholar 

  20. Vitale MA, Villotti G, d’Alba L, Frontespezi S, Iacopini F, Iacopini G. Preoperative colonoscopy after self-expandable metallic stent placement in patients with acute neoplastic colon obstruction. Gastrointest Endosc 2006;63:814–819. doi:10.1016/j.gie.2005.12.032.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, School of Medicine, Kyungpook National University, 50 Samduk-dong 2ga Jung-gu, Daegu, South Korea

    In Ja Park, Gyu-Seog Choi, Byoung Mo Kang, Kyoung Hoon Lim & Soo-Han Jun

  2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, 50 Samduk-dong 2ga Jung-gu, Daegu, South Korea

    Seong Woo Jeon

  3. Daehang Hospital, Seoul, South Korea

    In-Taek Lee

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  1. In Ja Park
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  2. Gyu-Seog Choi
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  3. Byoung Mo Kang
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  4. Kyoung Hoon Lim
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Correspondence to Gyu-Seog Choi.

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Park, I.J., Choi, GS., Kang, B.M. et al. Comparison of One-Stage Managements of Obstructing Left-Sided Colon and Rectal Cancer: Stent-Laparoscopic Approach vs. Intraoperative Colonic Lavage. J Gastrointest Surg 13, 960–965 (2009). https://doi.org/10.1007/s11605-008-0798-y

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  • DOI: https://doi.org/10.1007/s11605-008-0798-y

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