Comparison between open and laparoscopic surgery after stent insertion for obstructive cancer

Toshiyuki Enomoto, MD, Yoshihisa Saida, MD, Emiko Takeshita, MD, Kazuhiro Takabayashi, MD, Sayaka Nagao, MD, Asako Takahashi, MD, Ryohei Watanabe, MD, Yasushi Nagaoka, MD, Koji Asai, MD, Yoichi Nakamura, MD, Manabu Watanabe, MD, Natsuya Katada, MD, Shinya Kusachi, MD. Department of Surgery, Toho University Ohashi Medical Center

Background and Aim: In our department, we have been preoperatively using colonic stents for obstructive colorectal cancer from 1993, and have performed many stent insertions. In this study, we compared the outcomes of laparoscopic surgery and open surgery after insertion of a colonic stent for obstructive colorectal cancer.

Methods: From April 2005 to August 2015, 79 patients who underwent surgical treatment after insertion of a colonic stent for obstructive colorectal cancer at Toho University Ohashi Medical Center in Japan. The results were evaluated and a comparison between patients who underwent laparoscopic surgery and open surgery was performed.

Results: We compared amount of bleeding, operative time, hospital stay, and complications in 45 cases of laparoscopic surgery and 34 cases of open surgery. The amount of blood loss in the laparoscopic surgery group was significantly less than that in the open surgery group. However, operative time was significantly shorter in the open surgery group than in the laparoscopic surgery group. The length of hospital stay was not statistically significantly different between the groups, but was shorter in the laparoscopic surgery group than in the open surgery group. There was no statistically significant difference in occurrence of postoperative surgical complications between the two groups.

Conclusion: In our study, the patients in the laparoscopic resection group had less blood loss, although no statistically significant difference was found in postoperative morbidity or mortality.

Laparoscopic resection after metallic stent insertion is a feasible and safe option with high quality of life for patients with obstructive colorectal cancer.