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THE ROLE OF LAPAROSCOPIC COLOSTOMY IN THE MANAGEMENT OF COMPLICATED NEOPLASMS INVOLVING THE RECTUM
J. MARKS MD, A. KARACHRISTOS, G. MARKS, MD
Patients with obstructing and fistulizing neoplasms of the rectum present a challenge to the surgeon and patient. Often times a diversion of the fecal stream is necessary while more definitive treatment options are being pursued. Creation of a laparoscopic colostomy allows an opportunity to stage the abdomen as well as form the stoma with minimal trauma to the patient. Between 1996 and 1998 we treated 15 patients with 11 adenocarcinomas and 2 squamous cell carcinomas of the anorectum, 1 cervical cancer, and 1 ovarian cancer. Of the 6 men and 9 women, 13 had obstruction of the rectum, 1 had a presacral abscess, and 1 patient with radiation proctitis had incontinence. Age ranged from 55 to 90 years (mean 73 yo). Procedures performed include: 9 sigmoid loop and 5 transverse loop colostomies and 1 ileostomy. Follow-up ranged between one to three years. There wee no perioperative mortalities. Morbidities were a slight stoma retraction, one stoma stenosis, and one chemoradiation enteritis with a partial small bowel obstruction, all of them treated conservatively. In one patient, unexpected upstaging occurred with the discovery of hepatic metastasis, not noted on preoperative CAT scan. Patients were discharged between post-operative day 1-3. Scheduled neoadjuvant chemoradiation began 3-8 days after discharge. Laparoscopic colostomy in the patient with a complicated neoplasm involving the rectum offers an opportunity to both treat the patient and sage their disease in an effective way with minimal morbidity and disruption of their definitive treatment plan. Laparoscopic colostomy should have a prominent role in the management of these patients.
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