Laparoscopic Colorectal Cancer Surgery after Perforation during Endoscopic Mucosal Dissection—Review of 5 Cases—

Abstract

[Objectives]
Iatrogenic perforation occurs as a complication of endoscopic submucosal dissection (ESD) for colorectal cancer. Conservative treatment is effective and emergent surgery is not necessary in most ESD-associated perforations. However, if tumor resection is endoscopically or pathologically insufficient, radical surgery would be necessary after conservative treatment. Our study aimed to evaluate the availability of laparoscopy-assisted colectomy (LAC) for cases with enforced conservative treatment after perforation during ESD.
[Methods]
Between January 2009 and December 2012, we performed LAC for 5 cases after conservative treatment for perforation during ESD (Perforation Group), 9 cases in which radical surgery had been deemed necessary based on pathological findings after successful endoscopic resection (Non-Perforation Group), and 200 ordinary cases diagnosed with colorectal cancer (Control Group). We studied the surgical outcomes of these 3 groups.
[Results]
In 4 cases in the perforation group, adhesion caused by perforation was not detected and the LAC procedure was not very difficult. Between these 3 groups, there was no significant difference in operation time, blood loss, postoperative hospital days, and intraoperative and postoperative complications.
[Conclusion]
This study suggests that LAC is available for early colorectal cancer cases with enforced conservative treatment after perforation during ESD.