Abstract:

Objective

To compare the short-term clinical efficacy observation of laparoscopic surgery or open surgery after placement of self-expandable metal stent in patients with obstructive leftsided colorectal cancer.

Methods

Clinical case data of patients with obstructive left-sided colorectal cancer who attended the Department of Anorectology of Gansu Provincial People's Hospital from June 2016 to June 2024 were retrospectively analyzed. Patients who were successfully stented and underwent radical surgery were included，and according to the different surgical methods，they were divided into the laparoscopic surgery group and the open surgery group to compare the short-term clinical efficacy between the two groups.

Results

A total of 64 patients were included，thirty-five in the laparoscopic surgery group and 29 in the open surgery group. There was no statistically significant difference between the two groups in terms of gender，age，BMI，tumor size，T stage，TNM stage，ASA grade and whether neoadjuvant therapy was performed（P＞0.05）. Compared with the intraoperative and postoperative conditions of patients in the two groups，the laparoscopic surgery group showed no significant differences in intraoperative bleeding （t=-3.004，P=0.008），postoperative time to exhaustion （t=-2.333，P=0.031），postoperative time to feeding （t=-2.240，P=0.038），postoperative hospitalization time （t=-2.418，P=0.030），time to first postoperative chemotherapy （t=-3.430，P=0.003），and stage I resection anastomosis （χ²=5.823，P=0.016） were better than those in the open surgery group，and the differences were all statistically significant； there was no statistically significant difference between laparoscopic surgery group and the open surgery group in terms of operation time，number of lymph nodes discharged，and death at 30 days （P＞0.05）. The incidence of early postoperative complications （wound infection，anastomotic leakage，intra-abdominal abscess，pneumonia，and other complications） was lower in the laparoscopic surgery group than in the open surgery group，and the overall difference was statistically significant （χ²=4.932，P＜0.026）.

Conclusion

For patients with obstructive left-sided colorectal cancer，self-expanding metal stent placement combined with laparoscopic surgery improves the intraoperative and postoperative conditions of the patients and reduces the rate of early complications，so its short-term therapeutic efficacy is better than that of open surgery.

Key words: Colorectal neoplasms, Intestinal obstruction, Self-expansion metallic stent, Laparoscopic surgery, Open surgery