Endolaparoscopic Approach vs Conventional Open Surgery in the Treatment of Obstructing Left-Sided Colon Cancer

OBJECTIVE: To compare self-expanding metal stents with emergency open surgery in the treatment of obstructing left-sided colon cancer. DESIGN: A randomized controlled trial. SETTING: An acute care hospital. PATIENTS: Adult patients with an obstructing tumor between the splenic flexure and rectosigmoid junction. MAIN OUTCOME MEASURES: Successful 1-stage operation, cumulative operative time, blood loss, hospital stay, pain score, and postoperative complications. RESULTS: Forty-eight patients were analyzed. Twenty-four underwent endoluminal stenting followed by laparoscopic resection and 24 underwent emergency open surgery. The 2 groups were matched for age, sex, body mass index, and disease staging. Patients in the endolaparoscopic group had significantly less cumulative blood loss and lower pain, incidence of anastomotic leak, and wound infection. Significantly more patients in the endolaparoscopic group had a successful 1-stage operation performed (16 vs 9, P = .04). None of the patients in the endolaparoscopic group had a permanent stoma compared with 6 patients in the emergency open surgery group (P = .03). CONCLUSIONS: Self-expanding metal stents serve as a safe and effective bridge to subsequent laparoscopic surgery in patients with obstructing left-sided colon cancer. This endolaparoscopic approach makes a 1-stage operation more feasible, is associated with reduced incidence of stoma creation, and allows patients with malignant large-bowel obstruction to enjoy the full benefit of minimally invasive surgery. Trial Registration clinicaltrials.gov Identifier: NCT00654212.