Abstract
Background
Little information has been available concerning the safety of laparoscopic resection of obstructive colorectal cancer after transanal endoscopic tube decompression (TETD). The aim of this study was to assess the short- and long-term outcomes of laparoscopic surgery following TETD for such advanced colorectal cancer.
Methods
A retrospective review was performed of 40 patients with obstructive left colorectal cancer whose distended bowels were treated with TETD before laparoscopic surgery, between January 2001 and March 2011 (TETD group). The elective surgery resulted in potentially curative resection of the tumor in all cases. Their clinical records were compared to those of 80 matched controls with nonobstructive left colorectal cancer resected laparoscopically during the same period (control group).
Results
Operative time, blood loss, and the rate of conversion to laparotomy were comparable between the two groups. There were no significant between-group differences in morbidity rates. Five-year overall survival rates in the TETD and control groups were 71.9 and 75.4 %, respectively, with no statistical difference. Disease-free survival rates after 5 years were also similar (TETD group, 64.5 % vs. control group, 66.3 %). There were no significant differences between the two groups in recurrence rates and patterns.
Conclusion
These results suggest that laparoscopic surgery following TETD is clinically and oncologically safe and could be a treatment of choice for obstructive left colorectal cancer.
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References
Barillari P, Aurello P, De Angelis R, Valabrega S, Ramacciato G, D’Angelo F, Fegiz G (1992) Management and survival of patients affected with obstructive colorectal cancer. Int Surg 77:251–255
Pearce NW, Scott SD, Karran SJ (1992) Timing and method of reversal of Hartmann’s procedure. Br J Surg 79:839–841
Deans GT, Krukowski ZH, Irwin ST (1994) Malignant obstruction of the left colon. Br J Surg 81:1270–1276
Cheung HY, Chung CC, Tsang WW, Wong JC, Yau KK, Li MK (2009) Endolaparoscopic approach vs conventional open surgery in the treatment of obstructing left-sided colon cancer: a randomized controlled trial. Arch Surg 144:1127–1132
Chung TS, Lim SB, Sohn DK, Hong CW, Han KS, Choi HS, Jeong SY (2008) Feasibility of single-stage laparoscopic resection after placement of a self-expandable metallic stent for obstructive left colorectal cancer. World J Surg 32:2275–2280
Fischer A, Schrag HJ, Goos M, Obermaier R, Hopt UT, Baier PK (2008) Transanal endoscopic tube decompression of acute colonic obstruction: experience with 51 cases. Surg Endosc 22:683–688
Horiuchi A, Nakayama Y, Tanaka N, Kajiyama M, Fujii H, Yokoyama T, Hayashi K (2005) Acute colorectal obstruction treated by means of transanal drainage tube: effectiveness before surgery and stenting. Am J Gastroenterol 100:2765–2770
Stipa F, Pigazzi A, Bascone B, Cimitan A, Villotti G, Burza A, Vitale A (2008) Management of obstructive colorectal cancer with endoscopic stenting followed by single-stage surgery: open or laparoscopic resection? Surg Endosc 22:1477–1481
Franks PJ, Bosanquet N, Thorpe H, Brown JM, Copeland J, Smith AM, Quirke P, Guillou PJ (2006) Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial). Br J Cancer 95:6–12
Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 20(3):CD003145
The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52
Jackson TD, Kaplan GG, Arena G, Page JH, Rogers SO Jr (2007) Laparoscopic versus open resection for colorectal cancer: a meta-analysis of oncologic outcomes. J Am Coll Surg 204:439–446
Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM, Brown JM (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068
Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229
Kim JS, Hur H, Min BS, Sohn SK, Cho CH, Kim NK (2009) Oncologic outcomes of self-expanding metallic stent insertion as a bridge to surgery in the management of left-sided colon cancer obstruction: comparison with nonobstructing elective surgery. World J Surg 33:1281–1286
Maruthachalam K, Lash GE, Shenton BK, Horgan AF (2007) Tumour cell dissemination following endoscopic stent insertion. Br J Surg 94:1151–1154
Park IJ, Choi GS, Kang BM, Lim KH, Lee IT, Jeon SW, Jun SH (2009) 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
Tan CJ, Dasari BV, Gardiner K (2012) Systematic review and meta-analysis of randomized clinical trials of self-expanding metallic stents as a bridge to surgery versus emergency surgery for malignant left-sided large bowel obstruction. Br J Surg 99:469–476
Japanese Society for Cancer of the Colon and Rectum (2009) Japanese classification of colorectal carcinoma, 2nd edn. Kanehara & Co Ltd, Tokyo
McArdle CS, McMillan DC, Hole DJ (2006) The impact of blood loss, obstruction and perforation on survival in patients undergoing curative resection for colon cancer. Br J Surg 93:483–488
Ohman U (1982) Prognosis in patients with obstructing colorectal carcinoma. Am J Surg 143:742–747
Serpell JW, McDermott FT, Katrivessis H, Hughes ES (1989) Obstructing carcinomas of the colon. Br J Surg 76:965–969
Wang HS, Lin JK, Mou CY, Lin TC, Chen WS, Jiang JK, Yang SH (2004) Long-term prognosis of patients with obstructing carcinoma of the right colon. Am J Surg 187:497–500
Disclosures
Drs. Yuji Shingu, Hiroshi Hasegawa, Eiji Sakamoto, Shunichiro Komatsu, Yasuhiro Kurumiya, Shinji Norimizu, and Yoshiro Taguchi have no conflicts of interest or financial ties to disclose.
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Shingu, Y., Hasegawa, H., Sakamoto, E. et al. Clinical and oncologic safety of laparoscopic surgery for obstructive left colorectal cancer following transanal endoscopic tube decompression. Surg Endosc 27, 3359–3363 (2013). https://doi.org/10.1007/s00464-013-2917-4
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DOI: https://doi.org/10.1007/s00464-013-2917-4