“Bridge to surgery” stenting and laparoscopic colorectal resection for obstructive colorectal cancer

Abstract

Obstructive colorectal cancer accounts for 3.1-15.8% of total colorectal cancer. It is not rare condition. Though obstructive colorectal cancer was often treated with emergent operation, it has made possible to be treated with elective surgery when utilizing endoscopic metal stent (EMS) placement that decompresses the enlarged intestine by transanal approach. In some cases, obstructive colorectal cancer can be treated with laparoscopic assisted colectomy (LAC) . In this study, we report cases of operable obstructive colorectal cancer that was treated by LAC after EMS placement.
Patients and Methods : We performed 108 EMS placements for operable obstructive colorectal cancer cases；99 cases were successfully performed and 9 cases of them underwent LAC. The patients′ age was between 45 and 93. It included 5 male and 4 female, all of them had 7 cases of sigmoid colon cancer, 1 case of rectum RS, 1 case of transverse colon. Stenting period was 6-13 days. All of the patients could undergo LAC with D3 level lymph node dissection.
Discussion : For obstructed cases, enlarged intestine become an obstacle of operative field view. So, such cases had not been applied to LAC. EMS placement, however, has made intestinal decompression and intestinal edema alleviation to expand the indication of LAC into obstructive colorectal cancer.
Conclusion : LAC is applicable for obstructive colorectal cancer with sufficient decompression by EMS placement or other methods.