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J Korean Surg Soc. 2006 Apr;70(4):301-306. Korean. Original Article.
Chang YS , Lee KY , Lee SH , Yoon C .
Department of Surgery, Kyung Hee University College of Medicine, Seoul, Korea.

PURPOSE: Laparoscopic surgery has been considered to be contraindicated for treating malignant colorectal obstruction. Stent insertion for obstructive colorectal cancer has recently allowed laparoscopic surgery to be performed by means of preoperative decompression and bowel preparation. This study is designed to evaluate the feasibility of performing laparoscopic surgery followed by stent insertion for treating malignant colorectal obstruction. Further, we wanted to compare the extent of surgery and the outcomes between laparoscopic and conventional colorectal surgery. METHODS: We reviewed nineteen cases of colorectal resections that were treated with stent insertion for malignant obstruction from Feb. 2003 and Aug. 2005. The results of stent insertion, the TNM stage, the extent of surgery and the postoperative courses were compared between the laparoscopic (n=9) and conventional groups (n=10). RESULTS: The stents were successfully inserted and the obstruction was relieved in all the cases. One case of laparoscopic approach was converted to open surgery due to massive tumor invasion to the adjacent organ. In terms of the extent of surgery, there were no significant differences in the tumor size (4.6 vs. 5.0 cm, respectively), the length of the specimen (24.6 vs. 25.3 cm, respectively), the number of retrieved lymph nodes (16.3 vs. 23.1, respectively), the proximal resection margin (12.1 vs. 14.1 cm, respectively), and the distal resection margin (5.4 vs. 5.0 cm, respectively) between the two groups. Also, there were no differences in the first feeding (3.8 vs. 4.4 days) and the postoperative hospital stay (10.0 vs. 11.7 days) between the two groups. CONCLUSION: The laparoscopic approach followed by preoperative stent insertion is a feasible option for treating obstructive colorectal cancer. There were no differences in the extent of surgery and the postoperative outcomes between the laparoscopic and conventional groups. The endoluminal-laparoscopic approach can be an effective strategy for treating obstructive colorectal cancer with its synergic advantage of being minimally invasive.

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