title: Higher rate of perineural invasion in stent-laparoscopic approach in comparison to emergent open resection for obstructing left-sided colon cancer.
abstract: OBJECTIVE
  We compared oncologic outcomes of laparoscopic surgery following self-expandable metallic stent (SEMS) insertion with one-stage emergency surgical treatment of obstructive left-sided colon and rectal cancers.
  
  
  METHODS
  From April 1996 to October 2007, 95 consecutive patients with left-sided obstructive colorectal cancers were included: 25 underwent preoperative stenting and elective laparoscopic surgery (SLAP) and 70 underwent emergency open surgery with intraoperative colon lavage (OLAV). Long-term oncologic outcomes were analyzed on an intention-to-treat basis.
  
  
  RESULTS
  There were no significant differences in baseline characteristics of patients between groups. Perineural invasion of the primary tumor was more frequent with SLAP (76 vs. 51.4 %, p = 0.033). The median follow-up was 51 months (range, 4-139 months). There were no significant differences between groups in 5-year overall survival rates (SLAP vs. OLAV, 67.2 vs. 61.6 %, p = 0.385). Five-year disease-free survival rates were also similar between groups (SLAP vs. OLAV, 61.2 vs. 60.0 %, p = 0.932).
  
  
  CONCLUSIONS
  Laparoscopic surgery after SEMS was feasible and safe for patients with obstructive left-sided colorectal cancer, and oncologic outcomes were comparable to emergency open surgery with intraoperative colon lavage. These results support the continued use of SLAP in this setting. Further large-scale study is needed to investigate any clinical impact attached to the higher rates of perineural invasion observed in SLAP.
authors.affiliation: Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hogukro, Buk-gu, Daegu 702-210, South Korea.
authors.forename: Hye Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Gyu-Seog
authors.initials: GS
authors.lastname: Choi
authors.forename: Jun Seok
authors.initials: JS
authors.lastname: Park
authors.forename: Soo Yeun
authors.initials: SY
authors.lastname: Park
authors.forename: Soo Han
authors.initials: SH
authors.lastname: Jun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000473:pathology / Q000601:surgery*; D007416:Intestinal Perforation / Q000209:etiology; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D010525:Peripheral Nerves / Q000473:pathology*; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome