title: Self-expandable metallic stent placement plus laparoscopy for acute malignant colorectal obstruction.
abstract: OBJECTIVE
  To investigate the clinical advantages of the stent-laparoscopy approach to treat colorectal cancer (CRC) patients with acute colorectal obstruction (ACO).
  
  
  METHODS
  From April 2008 to April 2012, surgery-related parameters, complications, overall survival (OS), and disease-free survival (DFS) of 74 consecutive patients with left-sided CRC presented with ACO who underwent self-expandable metallic stent (SEMS) placement followed by one-stage open (n = 58) or laparoscopic resection (n = 16) were evaluated retrospectively. The stent-laparoscopy group was also compared with a control group of 96 CRC patients who underwent regular laparoscopy without ACO between January 2010 and December 2011 to explore whether SEMS placement influenced the laparoscopic procedure or reduced long-term survival by influencing CRC oncological characteristics.
  
  
  RESULTS
  The characteristics of patients among these groups were comparable. The rate of conversion to open surgery was 12.5% in the stent-laparoscopy group. Bowel function recovery and postoperative hospital stay were significantly shorter (3.3 ± 0.9 d vs 4.2 ± 1.5 d and 6.7 ± 1.1 d vs 9.5 ± 6.7 d, P = 0.016 and P = 0.005), and surgical time was significantly longer (152.1 ± 44.4 min vs 127.4 ± 38.4 min, P = 0.045) in the stent-laparoscopy group than in the stent-open group. Surgery-related complications and the rate of admission to the intensive care unit were lower in the stent-laparoscopy group. There were no significant differences in the interval between stenting and surgery, intraoperative blood loss, OS, and DFS between the two stent groups. Compared with those in the stent-laparoscopy group, all surgery-related parameters, complications, OS, and DFS in the control group were comparable.
  
  
  CONCLUSIONS
  The stent-laparoscopy approach is a feasible, rapid, and minimally invasive option for patients with ACO caused by left-sided CRC and can achieve a favorable long-term prognosis.
authors.affiliation: Jia-Min Zhou, Yun-Shi Zhong, Mei-Dong Xu, Ping-Hong Zhou, Wei-Feng Chen, Qiang Shi, Zhong Ren, Tao Chen, Li-Qing Yao, Department of Endoscopic Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Jia-Min
authors.initials: JM
authors.lastname: Zhou
authors.forename: Li-Qing
authors.initials: LQ
authors.lastname: Yao
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Xu
authors.forename: Mei-Dong
authors.initials: MD
authors.lastname: Xu
authors.forename: Ping-Hong
authors.initials: PH
authors.lastname: Zhou
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Chen
authors.forename: Qiang
authors.initials: Q
authors.lastname: Shi
authors.forename: Zhong
authors.initials: Z
authors.lastname: Ren
authors.forename: Tao
authors.initials: T
authors.lastname: Chen
authors.forename: Yun-Shi
authors.initials: YS
authors.lastname: Zhong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000150:complications* / Q000401:mortality; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D015607:Stents
keywords: Colorectal cancer; Efficiency; Endoscopy; Laparoscopy; Safety; Self-expandable metallic stent
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