대한대장항문학회

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 bowel decompression and bowel preparation. The aim of this study is to evaluate the safety and the feasibility of a one-stage laparoscopic resection for obstructive left-sided colon cancer after stent insertion by comparing the results to those for nonobstructive left-sided colon cancer.

Methods: Between May 2006 and January 2009, a laparoscopic colorectal operation was performed on 18 consecutive patients with obstructive left-sided colon cancer after placement of a self-expandable stent by one colorectal surgeon, and the results were compared retrospectively to those for 43 patients with non-obstructive left-sided colon cancer who had undergone a laparoscopic procedure with the same surgeon. The collected data were the clinicopathologic characteristics, the perioperative complications, the oncologic outcomes, the postoperative recovery results, and the survival rate.

Results: The obstructive left-sided colon cancer group had significant benefits in retrieved lymph nodes (18.8±5.3 vs. 14.0±8.7, P=0.036), and distal resection margin (5.5±3.0 cm vs. 3.6±2.4 cm, P=0.011). There were no significant differences in other clinicopathological characteristics and oncologic outcomes, including the overall 3-yr survival rate, between the two groups.

Conclusion: Preoperative stent decompression followed by a laparoscopic colorectal resection is a safe and feasible option for treating obstructive left-sided colon cancer. A further large-scale prospective study should be performed to evaluate the long-term outcome of a one-stage laparoscopic resection using stent insertion in cases of obstructive left-sided colon cancer.