Laparoscopic two-stage operation for obstructive left-sided colorectal cancer: A case report

Abstract

Introduction and importance: The optimal treatment for obstructive left-sided colorectal cancer (OLCC) remains controversial. While open multi-stage operation is accepted widely, proportion of using laparoscopic surgery remains low with the conversion rate to open surgery up to 25%. Studies about performing laparoscopic surgery in all stages of treatment patients with resectable OLCC are scarce on literature, probably owing to difficulties of performing the operation in acute colonic obstruction. Here we report a patient with OLCC who was treated by laparoscopic two-stage operation in the same admission. Case presentation: A 87-year-old male admitted with symptoms and signs of low intestinal obstruction for 10 days. He had no severe comorbidities, except right hip joint replacement 10 years before. Clinical and CT findings confirmed obstructive middle rectal cancer which was at stage cT3N2Mx. Because endoscopic stent placement and neoadjuvant chemoradiotherapy were not available, multidisciplinary conference decided to perform laparoscopic two-stage operation. Laparoscopic loop colostomy was performed first with operative time of 65 minutes. In the first postoperative period, the patient was stabilized, fully evaluated and prepared for laparoscopic curative resection at postoperative day 12. The second intraoperative course was favourable with operative time of 215 minutes. The patient's recovery was uneventful. Total hospital stay was 20 days. Clinical discussion: Laparoscopic two-stage operation for OLCC is challenging but feasible. This approach requires both experienced laparoscopic colorectal surgeons and carefully selected patients. With the short interval between stages, adhesion and tumor spread may not be important consideration. Conclusion: Laparoscopic two-stage operation is feasible, effective, and should be considered in treatment of selected patients with OLCC. Highlights