Abstracts
1999 Digestive Disease Week

# 2080 THE ROLE OF LAPAROSCOPY IN THE INITIAL MULTIMODALITY MANAGEMENT OF NEAR OBSTRUCTING RECTAL CANCER.
Jonathan Koea, J Guillem, Memorial Sloan-Kettering Cancer Ctr, New York, NY; K Conlon, Colorectal Service and Gastric and Mixed Tumor Service, New York, NY; B Minsky, Depts of Surg and Radiation Oncology, New York, NY; A Cohen, Memorial Sloan-Kettering Cancer Ctr, New York, NY

Purpose: We have prospectively investigated the role of diagnostic laparoscopy in the multimodality management of locally advanced, near obstructing rectal cancer.
Results: Fourteen patients with near obstructing adenocarcinoma of the rectum (8 male; mean age 59 yrs) 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 min (range 67-94 min). All patients began a regular diet on post operative day 1 and the median time to discharge was 4 days (range 2-8 days). Four patients were found to have diffuse peritoneal carcinomatos not defined on pre operative CT scan. These patients died of disease within 6 months. Ten patients with advanced localized pelvic disease began combined modality therapy (CMT: 5040 rad external beam radiation therapy combined with 5FU/leucovorin) between 8 and 13 days (median 9 days) following laparoscopy and all underwent successful resection with clear margins between 3 and 7 months following laparoscopy.
Conclusions: 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 CMT and does not compromise the prospects of subsequent tumor resection.

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