Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 7, 2013; 19(33): 5513-5519
Published online Sep 7, 2013. doi: 10.3748/wjg.v19.i33.5513
Self-expandable metallic stent placement plus laparoscopy for acute malignant colorectal obstruction
Jia-Min Zhou, Li-Qing Yao, Jian-Min Xu, Mei-Dong Xu, Ping-Hong Zhou, Wei-Feng Chen, Qiang Shi, Zhong Ren, Tao Chen, Yun-Shi Zhong
Jia-Min Zhou, Yun-Shi Zhong, Mei-Dong Xu, Ping-Hong Zhou, Wei-Feng Chen, Qiang Shi, Zhong Ren, Tao Chen, Li-Qing Yao, Department of Endoscopic Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Jian-Min Xu, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Author contributions: Zhou JM, Yao LQ and Xu JM contribute equally to this study; Zhou JM, Zhong YS and Yao LQ designed the study; Xu JM performed the operation; Zhong YS, Xu MD, Zhou PH, Chen WF and Yao LQ performed the endoscopy; Zhou JM, Shi Q, Ren Z and Chen T analyzed the data and wrote the manuscript.
Supported by National Natural Science Funds of China, No. 81101566; and Scientific Funds of Shanghai Government, 11DZ2280400, 12QA1400600, XYQ2011017, 11411950500
Correspondence to: Dr. Yun-Shi Zhong, Department of Endoscopic Center, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032, China. zhongamy2002@126.com
Telephone: +86-21-64041990 Fax: +86-21-64038038
Received: March 18, 2013
Revised: June 17, 2013
Accepted: July 17, 2013
Published online: September 7, 2013
Abstract

AIM: To investigate the clinical advantages of the stent-laparoscopy approach to treat colorectal cancer (CRC) patients with acute colorectal obstruction (ACO).

METHODS: From April 2008 to April 2012, surgery-related parameters, complications, overall survival (OS), and disease-free survival (DFS) of 74 consecutive patients with left-sided CRC presented with ACO who underwent self-expandable metallic stent (SEMS) placement followed by one-stage open (n = 58) or laparoscopic resection (n = 16) were evaluated retrospectively. The stent-laparoscopy group was also compared with a control group of 96 CRC patients who underwent regular laparoscopy without ACO between January 2010 and December 2011 to explore whether SEMS placement influenced the laparoscopic procedure or reduced long-term survival by influencing CRC oncological characteristics.

RESULTS: The characteristics of patients among these groups were comparable. The rate of conversion to open surgery was 12.5% in the stent-laparoscopy group. Bowel function recovery and postoperative hospital stay were significantly shorter (3.3 ± 0.9 d vs 4.2 ± 1.5 d and 6.7 ± 1.1 d vs 9.5 ± 6.7 d, P = 0.016 and P = 0.005), and surgical time was significantly longer (152.1 ± 44.4 min vs 127.4 ± 38.4 min, P = 0.045) in the stent-laparoscopy group than in the stent-open group. Surgery-related complications and the rate of admission to the intensive care unit were lower in the stent-laparoscopy group. There were no significant differences in the interval between stenting and surgery, intraoperative blood loss, OS, and DFS between the two stent groups. Compared with those in the stent-laparoscopy group, all surgery-related parameters, complications, OS, and DFS in the control group were comparable.

CONCLUSION: The stent-laparoscopy approach is a feasible, rapid, and minimally invasive option for patients with ACO caused by left-sided CRC and can achieve a favorable long-term prognosis.

Keywords: Self-expandable metallic stent, Colorectal cancer, Endoscopy, Laparoscopy, Efficiency, Safety

Core tip: Our study compared long-term survival between left-sided colorectal cancer (CRC) patients with acute colorectal obstruction (ACO) who had undergone self-expandable metallic stent (SEMS) placement followed by one-stage laparoscopic (stent-laparoscopy group) and open resection (stent-open group). Long-term survival in left-sided CRC patients without ACO who had undergone laparoscopic resection (control group) was compared with the stent-laparoscopy group. A stent-laparoscopy approach did not reduce long-term survival by influencing CRC oncological characteristics. Surgery-related parameters and postoperative complications in the stent-laparoscopy group were also compared with those of the other two groups; the results indicated that SEMS placement did not influence subsequent laparoscopic procedures.