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

T. Yamada; T. Shimura; E. Sakamoto; Y. Kurumiya; S. Komatsu; H. Iwasaki; S. Nomura; H. Kanie; H. Hasegawa; E. Orito; T. Joh

doi:10.1055/s-0032-1326030

Endoscopy, Inhaltsverzeichnis

Endoscopy 2013; 45(04): 265-271
DOI: 10.1055/s-0032-1326030

Original article

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

T. Yamada

¹Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan

,

T. Shimura

²Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

³Vascular Biology Program and Department of Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA

⁴Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA

,

E. Sakamoto

⁵Department of Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan

,

Y. Kurumiya

⁵Department of Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan

,

S. Komatsu

⁵Department of Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan

,

H. Iwasaki

¹Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan

,

S. Nomura

¹Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan

,

H. Kanie

¹Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan

,

H. Hasegawa

⁵Department of Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan

,

E. Orito

¹Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan

,

T. Joh

²Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

› Institutsangaben

Abstract

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.

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