Download PDF
Endoscopy 2013; 45(04): 265-271
DOI: 10.1055/s-0032-1326030
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Preoperative drainage using a transanal tube enables elective laparoscopic colectomy for obstructive distal colorectal cancer

T. Yamada
1   Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
,
T. Shimura
2   Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
3   Vascular Biology Program and Department of Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
4   Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
,
E. Sakamoto
5   Department of Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
,
Y. Kurumiya
5   Department of Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
,
S. Komatsu
5   Department of Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
,
H. Iwasaki
1   Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
,
S. Nomura
1   Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
,
H. Kanie
1   Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
,
H. Hasegawa
5   Department of Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
,
E. Orito
1   Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
,
T. Joh
2   Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
› Author Affiliations
Further Information

Publication History

submitted 29 March 2012

accepted after revision 14 November 2013

Publication Date:
15 January 2013 (online)

Also available at
    Permissions and Reprints

Background and study aims: Acute colorectal obstruction (ACO) often accompanies colorectal cancer (CRC) and requires urgent treatment, but achieving elective laparoscopy-assisted colectomy (LAC) is difficult in this setting. The aim of the current study was to assess the clinical outcomes of a transanal tube (Dennis colorectal tube [DCT]) for CRC with ACO, focusing in particular on the impact of the DCT on subsequent elective LAC.

Patients and methods: Among 1142 patients who underwent surgery for CRC between January 2007 and December 2011, 92 patients with ACO were identified retrospectively. Of these 92 patients, the DCT procedure was performed in 66 patients who fulfilled the indications for DCT, and these patients were included in the study.

Results: All 66 patients presented with complete obstruction. Technical and clinical success rates for DCT were 93.9 % and 86.4 %, respectively. Perforation after DCT occurred in 4.5 % and the mortality rate was 1.5 %. The rate of LAC was 48.5 %, and the rate of primary stoma was 13.6 %. For curative stage II/III CRC with ACO, DCT resulted in a primary stoma rate of 13.6 %, a one-stage surgery rate of 90.9 %, a LAC rate of 50.0 %, and a 3-year survival rate of 73.1 %. For stage II/III CRC cases with clinical success by DCT, the one-stage surgery rate was 97.4 % and the LAC rate was 56.4 %.

Conclusions: DCT achieved a high rate of clinical success and enabled safe one-stage surgery and LAC for CRC with ACO. DCT followed by LAC is proposed as a promising non-invasive strategy for CRC with ACO.

 

  • References

  • 1 International Agency for Research on Cancer. GLOBOCAN. 2008 Available from: http://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=900 Last accessed: 29 March 2012
    PubMedGoogle Scholar
  • 2 Chang GJ, Rodriguez-Bigas MA, Skibber JM et al. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 2007; 99: 433-441
    CrossrefPubMedGoogle Scholar
  • 3 Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350: 2050-2059
    CrossrefPubMedGoogle Scholar
  • 4 Veldkamp R, Kuhry E, Hop WC et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 2005; 6: 477-484
    CrossrefPubMedGoogle Scholar
  • 5 Guillou PJ, Quirke P, Thorpe H et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005; 365: 1718-1726
    CrossrefPubMedGoogle Scholar
  • 6 Biondo S, Pares D, Frago R et al. Large bowel obstruction: predictive factors for postoperative mortality. Dis Colon Rectum 2004; 47: 1889-1897
    CrossrefPubMedGoogle Scholar
  • 7 De Salvo GL, Gava C, Pucciarelli S et al. Curative surgery for obstruction from primary left colorectal carcinoma: primary or staged resection?. Cochrane Database Syst Rev 2004; CD002101
    PubMedGoogle Scholar
  • 8 Phillips RK, Hittinger R, Fry JS et al. Malignant large bowel obstruction. Br J Surg 1985; 72: 296-302
    CrossrefPubMedGoogle Scholar
  • 9 Mulcahy HE, Skelly MM, Husain A et al. Long-term outcome following curative surgery for malignant large bowel obstruction. Br J Surg 1996; 83: 46-50
    CrossrefPubMedGoogle Scholar
  • 10 Mealy K, O’Broin E, Donohue J et al. Reversible colostomy – what is the outcome?. Dis Colon Rectum 1996; 39: 1227-1231
    CrossrefPubMedGoogle Scholar
  • 11 Pirlet IA, Slim K, Kwiatkowski F et al. Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial. Surg Endosc 2011; 25: 1814-1821
    CrossrefPubMedGoogle Scholar
  • 12 Mucci-Hennekinne S, Kervegant AG, Regenet N et al. Management of acute malignant large-bowel obstruction with self-expanding metal stent. Surg Endosc 2007; 21: 1101-1103
    CrossrefPubMedGoogle Scholar
  • 13 Sebastian S, Johnston S, Geoghegan T et al. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 2004; 99: 2051-2057
    CrossrefPubMedGoogle Scholar
  • 14 Horiuchi A, Maeyama H, Ochi Y et al. Usefulness of Dennis Colorectal Tube in endoscopic decompression of acute, malignant colonic obstruction. Gastrointest Endosc 2001; 54: 229-232
    CrossrefPubMedGoogle Scholar
  • 15 Horiuchi A, Nakayama Y, Tanaka N et al. Acute colorectal obstruction treated by means of transanal drainage tube: effectiveness before surgery and stenting. Am J Gastroenterol 2005; 100: 2765-2770
    CrossrefPubMedGoogle Scholar
  • 16 Sobin L, Gospodarowicz M, Wittekind C. TNM classification of malignant tumours. 7th. edn. Hoboken, NJ: John Wiley & Sons, Inc; 2009
    Google Scholar
  • 17 Dindo D, Demartines N, Clavien PA et al. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-213
    CrossrefPubMedGoogle Scholar
  • 18 Katoh H, Yamashita K, Wang G et al. Prognostic significance of preoperative bowel obstruction in stage III colorectal cancer. Ann Surg Oncol 2011; 18: 2432-2441
    CrossrefPubMedGoogle Scholar
  • 19 Wang HS, Lin JK, Mou CY et al. Long-term prognosis of patients with obstructing carcinoma of the right colon. Am J Surg 2004; 187: 497-500
    CrossrefPubMedGoogle Scholar
  • 20 Tekkis PP, Kinsman R, Thompson MR et al. The Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg 2004; 240: 76-81
    CrossrefPubMedGoogle Scholar
  • 21 Smothers L, Hynan L, Fleming J et al. Emergency surgery for colon carcinoma. Dis Colon Rectum 2003; 46: 24-30
    CrossrefPubMedGoogle Scholar
  • 22 Saida Y, Sumiyama Y, Nagao J et al. Long-term prognosis of preoperative “bridge to surgery” expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation. Dis Colon Rectum 2003; 46: 44-49
    PubMedGoogle Scholar
  • 23 Law WL, Choi HK, Chu KW. Comparison of stenting with emergency surgery as palliative treatment for obstructing primary left-sided colorectal cancer. Br J Surg 2003; 90: 1429-1433
    CrossrefPubMedGoogle Scholar
  • 24 Martinez-Santos C, Lobato RF, Fradejas JM et al. Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum 2002; 45: 401-406
    CrossrefPubMedGoogle Scholar
  • 25 van Hooft JE, Bemelman WA, Oldenburg B et al. Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol 2011; 12: 344-352
    CrossrefPubMedGoogle Scholar
  • 26 Tan CJ, Dasari BV, Gardiner K. Systematic review and meta-analysis of randomized clinical trials of self-expanding metallic stents as a bridge to surgery versus emergency surgery for malignant left-sided large bowel obstruction. Br J Surg 2012; 99: 469-476
    CrossrefPubMedGoogle Scholar
  • 27 Buunen M, Veldkamp R, Hop WC et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 2009; 10: 44-52
    CrossrefPubMedGoogle Scholar
  • 28 Bonjer HJ, Hop WC, Nelson H et al. Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 2007; 142: 298-303
    CrossrefPubMedGoogle Scholar
  • 29 Stipa F, Pigazzi A, Bascone B et al. Management of obstructive colorectal cancer with endoscopic stenting followed by single-stage surgery: open or laparoscopic resection?. Surg Endosc 2008; 22: 1477-1481
    CrossrefPubMedGoogle Scholar
  • 30 Cheung HY, Chung CC, Tsang WW et al. Endolaparoscopic approach vs conventional open surgery in the treatment of obstructing left-sided colon cancer: a randomized controlled trial. Arch Surg 2009; 144: 1127-1132
    CrossrefPubMedGoogle Scholar
  • 31 Small AJ, Coelho-Prabhu N, Baron TH. Endoscopic placement of self-expandable metal stents for malignant colonic obstruction: long-term outcomes and complication factors. Gastrointest Endosc 2010; 71: 560-572
    CrossrefPubMedGoogle Scholar