Minimally invasive treatment of malignant obstruction of the left colon: Self-expandable endoluminal stent and laparoscopic colectomy. Preliminary results

Introduction: The most widely used treatment of malignant obstruction consists of resection of the colonic segment and terminal colostomy (Hartmann's operation). Alternative techniques to avoid stoma are subtotal colectomy or segmental colectomy with intraoperative lavage. However, although there are many arguments in favor of surgery in a single intervention, this is possible less than 70% of patients. Another technical alternative to this intervention consists of the implantation of a self-expandable stent with palliative intent or as a previous step to elective conventional colectomy. This avoids the need for colostomy. In addition, the possibility of laparoscopic colectomy allows a minimally invasive approach to be used with all the advantages that this provides in terms of patient comfort. Patients and methods: From a prospective database of 250 patients with colorectal disease who underwent laparoscopic surgery in our department, we reviewed the results obtained in five patients who had previously undergone placement of a stent to resolve complete obstruction due to cancer of the left colon. Demographic data, tumoral characteristics, data concerning the placement of the stent and laparoscopic surgery as well as postoperative outcome were collected. Results: The lesions were localized in the sigmoidrectum (one patient), sigmoid colon (two patients) and descending colon (two patients). The stent resolved obstruction in the five patients who tolerated oral feeding 24 hours after placement. One patient presented an episode of mild rectorrhagia that was selflimiting without the need for transfusion. The five patients underwent surgery 8 days (range: 6-14) after stent placement. One patient required conversion to open surgery and another required hand-assisted laparoscopic surgery. The need for conversion was not caused by difficulties related to the stent. Conclusions: The preliminary results of the combination of stent-elective surgery reinforce the advantages of this option, especially if two minimally invasive techniques (stent and laparoscopic colectomy) are performed consecutively. This avoids the need for stoma and provides the clinical advantages of the laparoscopic approach.