VM2 - A Three-trocar Laparoscopic Left Colectomy After Laparoscopic Discharge Stoma: Minimally Invasive Management of Obstructed Colonic Cancer

ONGOING VIDEOS

Location: ASCRS Connect Lounge, Hall B1/B2, Ground Level

Video Presentation(s)

Sarah Benammi, MD

Attending physician
MOHAMED VI UNIVERSITY OF SCIENCES AND HEALTH
Casablanca, Grand Casablanca, Morocco

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

NK

Nassim Kadim, MD

Resident
UNIVERSITY MOHAMED VI OF HEALH SCIENCES
Casablanca, Grand Casablanca, Morocco

Disclosure information not submitted.
IB

Imane Boutaleb Joutei, MD

Resident
Mohamed VI University of Health Sciences
Casablanca, Grand Casablanca, Morocco

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AN

Abdellah Nouri, MD

Professor
Mohamed VI University of Health Sciences
Casablanca, Grand Casablanca, Morocco

Disclosure information not submitted.
AB

Ahmed Bensaad, MD

Professor
Mohamed VI University of Health Sciences
Casablanca, Grand Casablanca, Morocco

Disclosure information not submitted.
YG

Youssef Ghaddou, MD

Professor
Mohamed VI University of Health Sciences
Casablanca, Grand Casablanca, Morocco

Disclosure information not submitted.
MB

Mohamed Bouziane, MD

Professor
UNIVERSITY MOHAMED VI OF HEALH SCIENCES
Casablanca, Grand Casablanca, Morocco

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Senior Author(s)

KS

Khalid Sair, MD

Professor
Mohamed VI University of Health Sciences
Casablanca, Grand Casablanca, Morocco

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

AF

Abdelaziz Fadil, MD

Professor
UNIVERSITY MOHAMED VI OF HEALH SCIENCES
Casablanca, Grand Casablanca, Morocco

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Sarah Benammi, MD: This individual has no financial relationships with ineligible companies.

Khalid Sair, MD: This individual has no financial relationships with ineligible companies.

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Purpose/Background: The ideal approach to treating obstructive left-sided colorectal cancer (OLCC) is still debated among medical professionals. While open multi-stage procedures are commonly endorsed, the utilization of laparoscopic techniques is relatively limited. Research focusing on laparoscopic surgery for all stages of patients with resectable OLCC is limited, likely due to the challenges associated with operating on acute colonic obstructions. We present a surgical video of laparoscopic left colectomy using 3 trocars after a laparoscopic discharge stoma.

Methods/Interventions: This was a 70-year-old female with no comorbidities was admitted with symptoms and signs of low intestinal obstruction for 5 days. Clinical and CT-scan findings confirmed obstructive left colon cancer which was at stage cT3N0Mx. We performed a laparoscopic two-stage operation with initially laparoscopic discharge stoma. The patient was stabilized, and a complete assessment of the tumor lesion was conducted including colonoscopy and sigmoidoscopy with biopsy and distant metastasis assessment. After a multidisciplinary discussion, laparoscopic curative resection at postoperative day 16 was done. The postoperative histology was favorable. The patient's recovery was uneventful and was discharged on day 5. The total hospital stay was 22 days.

Results/Outcomes: The effectiveness of laparoscopic surgery for managing acute colonic obstruction remains a topic of debate. Historically, such conditions have been viewed as contraindications for laparoscopic approaches due to concerns over limited visibility and the potential for damaging the swollen bowel during manipulation. However, our case illustrates the feasibility, safety, and advantages of employing laparoscopic techniques in both stages of treatment for a patient with obstructive left-sided colorectal cancer (OLCC). By carefully selecting a patient with moderate abdominal distention and no significant cardiac or pulmonary issues, we encountered minimal difficulties during the initial laparoscopic procedure. This led to a swift postoperative recovery, which allowed for the optimization of the patient’s condition, a thorough multidisciplinary assessment, and effective preparation for the subsequent treatment phase. Finally, we used the stoma as a 4th trocar achieving tension of the left colon during dissection.
Implementing our approach not only achieves a curative resection for obstructive colorectal cancer but also provides the advantages of minimally invasive surgery across both stages of treatment.

Conclusion/Discussion: Laparoscopic two-stage operation for obstructive left-sided colorectal cancer is feasible and effective. This method relies on skilled laparoscopic colorectal surgeons and a selection of suitable patients. Given the brief time frame between the two stages, concerns about adhesion formation and tumor dissemination are less significant.