title: Comparison of laparoscopic versus open surgery in a three-stage operation for obstructive left-sided colorectal cancer.
abstract: BACKGROUND
  Treatment for obstructive left-sided colorectal cancer (OLCC) typically consists of a three-staged procedure. During the first stage, the obstruction is managed with diversion colostomy. Traditionally in the second stage, we perform open resection for the primary tumor. In this study, we evaluated the feasibility of laparoscopic resection of OLCC with diversion colostomy in terms of operative results and short-term outcomes.
  
  
  METHODS
  A total of 20 patients underwent laparoscopic resection for OLCC (study group), 48 patients underwent open resection for OLCC (control group 1), and 53 patients underwent laparoscopic resection for non-OLCC (control group 2). Afterwards, results from the procedures were obtained and clinical data were analyzed.
  
  
  RESULTS
  The operative time was significantly longer in the study group than in the control group 1 (153 minutes vs. 126 minutes, p = 0.041), and the length of hospitalization was shorter in the study group than in the control group 1 (5.3 days vs. 7.6 days, p = 0.032). Regarding the operative results and short-term outcomes, there were no significant differences between the study group and control group 2. Colostomy retraction was a specific morbidity which occurred in two patients of the study group.
  
  
  CONCLUSIONS
  Laparoscopic resection of OLCC with diversion colostomy is feasible. Abdominal cavity adhesion is only limited. We strongly recommend that laparoscopic resection should be performed at least 2 weeks after diversion colostomy, and the plastic rod should be left in place during the pneumoperitoneum to reduce the risk of colostomy retraction.
authors.affiliation: Division of Colorectal Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Jui-Ho
authors.initials: JH
authors.lastname: Wang
authors.affiliation: Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Ya-Hsin
authors.initials: YH
authors.lastname: Kung
authors.affiliation: Division of Colorectal Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Tai-Ming
authors.initials: TM
authors.lastname: King
authors.affiliation: Division of Colorectal Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Min-Chi
authors.initials: MC
authors.lastname: Chang
authors.affiliation: Division of Colorectal Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address: ss851124@gmail.com.
authors.forename: Chao-Wen
authors.initials: CW
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000150:complications / Q000601:surgery*; D003125:Colostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: colorectal cancer; laparoscopic; left-sided; obstructive