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 laparoscopy in the multimodality management of locally advanced, near-obstructing rectal cancer. Fourteen patients with near-obstructing adenocarcinoma of the rectum (8 men and 6 women; mean age 49 years) underwent staging laparoscopy and formation of a sigmoid loop colostomy (n = 7), transverse colostomy (n = 4), or ileostomy (n = 3). The mean operative time was 78 minutes (range 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 patients were found to have diffuse peritoneal carcinomatosis not defined on preoperative CT scan. These patients died of disease within 6 months. Ten patients with advanced, localized pelvic disease began preoperative combined-modality treatment (5040 cGy external-beam radiation therapy in conjunction with 5-fluorouracil/leucovorin) between 8 and 13 days (median 9 days) following laparoscopy, and all underwent successful resection with clear margins in a median time of 12 weeks following laparoscopy. In the initial management of patients with near-obstructing advanced rectal cancer, laparoscopy can be both therapeutic and diagnostic by clarifying the site of the primary tumor, identifying patients with unsuspected peritoneal disease, and facilitating the formation of a defunctioning stoma with minimal morbidity. This leads to the early commencement of preoperative combined-modality treatment and does not compromise the prospects of subsequent tumor resection.