Endolaparoscopic approach vs conventional open surgery in the treatment of obstructing left-sided colon cancer: a randomized controlled trial.
OBJECTIVE
To compare self-expanding metal stents with emergency open surgery in the treatment of obstructing left-sided colon cancer.


METHODS
A randomized controlled trial.


METHODS
An acute care hospital.


METHODS
Adult patients with an obstructing tumor between the splenic flexure and rectosigmoid junction.


METHODS
Successful 1-stage operation, cumulative operative time, blood loss, hospital stay, pain score, and postoperative complications.


RESULTS
Forty-eight patients were analyzed. Twenty-four underwent endoluminal stenting followed by laparoscopic resection and 24 underwent emergency open surgery. The 2 groups were matched for age, sex, body mass index, and disease staging. Patients in the endolaparoscopic group had significantly less cumulative blood loss and lower pain, incidence of anastomotic leak, and wound infection. Significantly more patients in the endolaparoscopic group had a successful 1-stage operation performed (16 vs 9, P = .04). None of the patients in the endolaparoscopic group had a permanent stoma compared with 6 patients in the emergency open surgery group (P = .03).


CONCLUSIONS
Self-expanding metal stents serve as a safe and effective bridge to subsequent laparoscopic surgery in patients with obstructing left-sided colon cancer. This endolaparoscopic approach makes a 1-stage operation more feasible, is associated with reduced incidence of stoma creation, and allows patients with malignant large-bowel obstruction to enjoy the full benefit of minimally invasive surgery. Trial Registration clinicaltrials.gov Identifier: NCT00654212.
Cheung
Hester Yui Shan
HY
Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, China. yui92549@yahoo.com
Chung
Chi Chiu
CC
Tsang
Wilson Wen Chieng
WW
Wong
James Cheuk Hoo
JC
Yau
Kevin Kwok Kay
KK
Li
Michael Ka Wah
MK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015607:Stents; D016896:Treatment Outcome