Hybrid approach for left-sided colonic carcinoma obstruction; a case report
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
Hybrid approach for left-sided colonic carcinoma obstruction; a case report Atthaphorn Trakarnsanga, Thawatchai Akaraviputh*, Asada Methasate and Vitoon Chinswangwatanakul
Abstract Traditionally, there are several approaches to manage left-sided colonic carcinoma obstruction, such as tumor resection with primary anastomosis, tumor resection with end-colostomy and loop-colostomy. Recently, colonic stent insertion was introduced as a bridge prior to definite surgery. We demonstrated a hybrid approach for obstructed sigmoid carcinoma using colonic stent, followed by single incision laparoscopic colectomy (SILC). A 58 year-old man presented with complete left-sided colonic obstruction. He underwent emergency colonoscopy with metallic stent placement. One week later, he was performed SILC. He recovered well after the operation without any postoperative complications. The pathological result showed adequacy of oncologic resection. This hybrid approach of colonic stent insertion and SILC can be safely performed. Keywords: Left-sided colonic obstruction Colonic stent, Single-incision laparoscopic colectomy
Background Eight to twenty-nine percent of colorectal cancer patients presented with colonic obstruction [1-4]. The obstruction of colon is one of the most common emergency presentations of colorectal cancer, especially lesion at left-sided, which frequently causes morbidity and mortality. Management of left-sided colonic obstruction can be done in several ways such as tumor resection with primary anastomosis (one-staged), tumor resection with end-colostomy (two-staged) and emergency transverse loop-colostomy. Interestingly, recent publications supported the colonic stent insertion as a bridging therapy before definite surgery. Traditional approach, patients usually ended up with stoma. From previous reports, one-third of stomas are never reversed [1,5]. For this reason, colonic stent may prevent undesirable colostomy. Laparoscopic colectomy for colon cancer treatment became more popular in the past decade. The data from several studies [6-13] showed better short-term benefits, such as less postoperative pain due to smaller incision, rapid return of bowel function, shorter hospitalization and faster return to normal activities. Moreover, short* Correspondence: [email protected] Minimally Invasive Surgery unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
term complications, morbidities and mortality were not different from traditional approach. Importantly, there are no difference of oncologic outcomes between laparoscopic and open surgery in terms of local recurrence and percentage of adequate margin [6-13]. For these reasons, laparoscopic colectomy was not inferior to conventional surgery and provided better short-term advantages [14]. Recently, there were several minimally invasive surgical techniques introduced, for examples, Hand-assisted laparoscopic colectomy (HALC),
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