Role of laparoscopy in the initial multimodality management of patients with near-obstructing rectal cancer

The purpose of this study was to investigate the role of diagnostic laparos copy in the multimodality management of locally advanced, near-obstructing rectal cancer. Fourteen patients with near-obstructing adenocarcinoma of th e rectum (8 men and 6 women; mean age 49 years) underwent staging laparosco py and formation of a sigmoid loop colostomy (n = 7), transverse colostomy (n = 4), or ileostomy (n = 3). The mean operative time was 78 minutes (rang e 67 to 94 minutes). All patients began a regular diet on postoperative day 1 and the median time to discharge was 4 days (range 2 to 8 days). Four pa tients were found to have diffuse peritoneal carcinomatosis not defined on preoperative CT scan. These patients died of disease within 6 months. Ten p atients with advanced, localized pelvic disease began preoperative combined -modality treatment (5040 cGy external-beam radiation therapy in conjunctio n with 5-fluorouracil/leucovorin) between 8 and 13 days (median 9 days) fol lowing laparoscopy, and all underwent successful resection with clear margi ns in a median time of 12 weeks following laparoscopy. In the initial manag ement of patients with near-obstructing advanced rectal cancer, laparoscopy can be both therapeutic and diagnostic by clarifying the site of the prima ry tumor, identifying patients with unsuspected peritoneal disease, and fac ilitating the formation of a defunctioning stoma with minimal morbidity. Th is leads to the early commencement of preoperative combined-modality treatm ent and does not compromise the prospects of subsequent turner resection.