| Background: Malignant colorectal cancer estimated around 80% of colonic obstruction.About 20% of CRC patients presents with acute colonic obstruction at the emergency department which mandates an urgent intervention to decompress the colon.Despite increased use of laparoscopic colectomy and more surgeons becoming familiar with its use,however,laparoscopic technique is not feasible in acute obstructive lesion caused by colorectal cancer because of distended colon which makes no room for laparoscopic instruments to dissect the tumor and with the lack or limited vision,the distended bowel is high likely get injured easily.There has been increased evidence suggesting that preoperative insertion of SEMS increased the chance to perform laparoscopic approach in acute obstructive colorectal cancer patients.Methods: A total number of 29 patients who presented with acute obstruction of CRC from January 2013 to December 2016 were fullified the inclusion and exclusion criteria of this study,22 patients have had preoperative placement of SEMS followed by elective colon resection(10 patient laparoscopic and 12 patients open resection,respectively)and an emergency surgery with intraoperative lavage was done for 7 patients and grouped as following:(1)SEMS-LAP(10 patients),(2)SEMS-OPEN(12 patients)and(3)OPEN+LAVAGE(7 patients).And finally we compared the SEMS-LAP group to ten patients of elective laparoscopic colon resection of CRC without SEMS(GROUP 4)Results: The mean age between the three interventions have not shown statistically significant,in SEMS-LAP group(62±12.26 years),SEMS-OPEN group(68±11.56 years),and OPEN+LAVAGE group(65±8.94 years),(p>0.05),and the other preoperative data also didn't show statistically significant different such as gender,tumor location and co-morbidity disease.The operation time was statistically significant different in group SEMS-OPEN group compared to SEMS-LAP and OPEN+LAVAGE groups(p<0.05)and for SEMS-OPEN and OPEN+LAVAGE group have not shown statistical significant different,(p>0.05),the median operation time between them was 275(203,336)minutes,160(150,176)minutes and260(240,340)minutes,respectively.ESBL(estimated blood loss)in group SEMS-LAP group has shown statistically different when compared to other two groups(SEMS-OPEN and OPEN+LAVAGE groups)(p<0.05)and SEMS-OPEN and OPEN+LAVAGE groups didn't show statistical significant different(p>0.05),the median estimated blood loss was 50(20,100)ml in SEMS-LAP,100(52,100)ml in SEMS-OPEN and 100(100,100)ml in OPEN+LAVAGE respectively.Number of lymph node dissected in SEMS-LAP group was statistical significant different compared to other two groups(p<0.05),and was no statistical significant difference was seen between SEMS-OPEN and OPEN+LAVAGE groups(p>0.05),the mean number of lymph node dissected between them was 19±6.27 in SEMS-LAP group,12±2.39 in SEMS-OPEN group and 11±9.12 in OPEN+LAVAGE group.Duration of ICU stay was statistically significant different in SEMS-LAP group when compared to other two group(p<0.05)and return of bowel function time was showed statistically different in SEMS-LAP group compared to the other two procedure(p<0.05),ICU duration and return bowel function time was not shown statistical significant different in both SEMS-OPEN and OPEN+LAVAGE groups(p>0.05),the median ICU stay was 0(0,0.25)days in SEMS-LAP,1(0,2)days in SEMS-OPEN and 1(1,2)days,and The median time for bowel return was 2.5(2,3)days in SEMS-LAP group,4(3,5)days in SEMS-OPEN group and 4(3,4)days OPEN+LAVAGE group,respectively.Oral feeding time in SEMS-LAP group statistically was significant different when compared to the other two intervention(p<0.05),no statistically significant different shown between SEMS-OPEN and OPEN+LAGAVE groups(p>0.05),the mean feeding time between the groups was 4±0.84,5±0.89 and 6±0.97 days.Primary anastomosis was done in all the cases of SEMS-LAP group,and stoma creation was performed in one case in each of SEMS-OPEN and OPEN+LAVAGE groups.There was no statistical difference in the rate of primary anastomosis and stoma creation,p>0.05.The median time of hospital stay was less in SEMS-LAP but statistically was not significant,15(13.5,22.5)days in SEMS-LAP group,22(17.5,28)days in SEMS-OPEN group and17(15 35)days in OPEN+LAVAGE group,p>0.05.Finally we did perform a comparison between SEMS-LAP with subgroup of elective laparoscopic colectomy according to their intra and postoperative surgical parameters such as ESBL,duration of surgery,number of lymph node,ICU stay,bowel function return duration,oral feeding time and LOHS.All parameters didn't show statistical significant different(p>0.05),only the oral feeding time has showed statistical significant different p<0.05.Conclusions The presence of SEMS in the colon did not jeopardize or make any difficulties in laparoscopic use for colon resection,and have shown favoured outcome compared with other two intervention(SEMES-OPEN,OPEN+LAVAGE);therefore,laparoscopic colectomy is safe in acute obstructive left side colorectal cancer following placement of SEMS.Combining these two minimally invasive approaches is an advanced way to manage this emergency condition which is better than the other options available for this situation.The same result outcome was achieved when SEMS-LAP compared to the patients underwent elective laparoscopic colectomy without obstruction. |
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