Invest Clin 66(3): 313 - 321, 2025 https://doi.org/10.54817/IC.v66n3a07

Corresponding author: Zhengquan Ta. Department of General Surgery, Baoji High-tech Hospital, No. 19, Gaoxin

4th Road, Baoji 721000, Shaanxi, China. Email: 18729179036@163.com

Clinical effect of laparoscopic surgery

on patients with colon cancer complicated

with intestinal obstruction.

Peihua Wu and Zhengquan Ta

Department of General Surgery, Baoji High-tech Hospital, Baoji, Shaanxi, China.

Keywords: colon cancer; intestinal obstruction; laparoscopic.

Abstract. Colon cancer is a malignant tumor of the digestive tract, often

complicated by intestinal obstruction. Laparoscopic surgery is widely used and

has the advantages of a small postoperative wound, less intraoperative blood

loss, and fewer postoperative complications. To measure the clinical effect of

laparoscopic surgery on patients with colon cancer complicated with intestinal

obstruction, the clinical data of 100 patients with this condition, who under-

went surgical treatment in the Baoji High-tech Hospital between January 2020

and December 2022, were retrospectively analyzed. Based on different surgical

methods, the patients were separated into a control group (CG, traditional lap-

arotomy) and an observation group (OG, laparoscopic surgery). The total clini-

cal effect of OG was superior to that of CG, as evidenced by shorter operation

times, reduced intraoperative blood loss, faster recovery times for intestinal

function, earlier discharge from bed, and shorter hospital stays. After surgery,

the NRS score declined in both groups, with a lower score in the OG. TNF-α,

IL-6, and CRP levels were elevated in both groups, but those in OG were lower.

The occurrence of complications in the OG was reduced compared to the CG.

Quality-of-life scores, including physical function, psychological state, social

communication, and self-care ability in the OG, were higher than those in the

CG. Laparoscopic surgery is effective for treating colon cancer complicated

with intestinal obstruction in patients, which can effectively lessen their pain,

reduce their inflammatory indicators, reduce the postoperative complications

of patients, and improve their quality of life.

314 Wu and Ta

Investigación Clínica 66(3): 2025

Efecto clínico de la cirugía laparoscópica en pacientes

con cáncer de colon complicado con obstrucción intestinal.

Invest Clin 2025; 66 (3): 313 – 321

Palabras clave: cáncer de colon; obstrucción intestinal; laparoscopía.

Resumen. El cáncer de colon es un tumor maligno del tracto digestivo, a

menudo complicado por obstrucción intestinal. La cirugía laparoscópica se utiliza

ampliamente y presenta ventajas tales como una herida postoperatoria pequeña,

menor pérdida de sangre intraoperatoria y menos complicaciones postoperatorias.

El objetivo de este estudio fue evaluar el efecto clínico de la cirugía laparoscópica

en pacientes con cáncer de colon complicado con obstrucción intestinal. Se anali-

zaron retrospectivamente los datos clínicos de 100 pacientes con cáncer de colon

complicado con obstrucción intestinal que se sometieron a tratamiento quirúrgico

en el Hospital de Alta Tecnología de Baoji entre enero de 2020 y diciembre de 2022.

Según los diferentes métodos quirúrgicos, los pacientes se dividieron en un gru-

po control (GC, laparotomía tradicional) y un grupo de observación (GO, cirugía

laparoscópica). El efecto clínico total del GO fue mejor que el del GC; el tiempo

operatorio, la pérdida de sangre intraoperatoria, el tiempo de recuperación de la

función intestinal, el tiempo para levantarse de la cama y la estancia hospitalaria

fueron menores en el GO. Después de la cirugía, la Puntuación de la Escala de Ries-

go Nutricional disminuyó en ambos grupos, siendo más baja en el GO. Los niveles

de TNF-α, IL-6 y la Proteína C reactiva se elevaron en ambos grupos, pero fueron más

bajos en el GO. La aparición de complicaciones fue menor en el GO que en el GC.

Las puntuaciones de calidad de vida, incluyendo función física, estado psicológico,

comunicación social y capacidad de autocuidado, fueron más altas en el GO que

en el GC. La cirugía laparoscópica es eficaz para tratar a pacientes con cáncer de

colon complicado con obstrucción intestinal, ya que puede reducir eficazmente el

dolor, los indicadores inflamatorios, las complicaciones postoperatorias y mejorar la

calidad de vida de los pacientes.

Received: 28-04-2025 Accepted: 03-08-2025

INTRODUCTION

Colon cancer is a malignant tumor of

the digestive tract that primarily occurs in

the colon, particularly at the junction of the

sigmoid colon and the rectum 1. Its inci-

dence is extremely high, ranking as high as

the third in the ranking of gastrointestinal

tumors 2. Intestinal obstruction is a relative-

ly common complication of colon cancer3.

The primary cause of intestinal obstruction

in patients with colon cancer is the tumor’s

narrowing of the intestinal cavity, resulting in

dry and hard stool that impedes the passage

of intestinal contents 4. The early symptoms

of acute intestinal obstruction are insidious

and difficult to detect, and the development

of acute intestinal obstruction is rapid after

onset, which can easily lead to death 5. At

present, surgery is often used in the clini-

cal therapy of colon cancer complicated with

intestinal obstruction 6. However, tradition-

al laparotomy not only easily leads to large

wounds, but is also prone to more complica-

Laparoscopic surgery on colon cancer 315

Vol. 66(3): 313 - 321, 2025

tions, which have adverse effects on the rapid

recovery of patients 7,8. Laparoscopic surgery

has been widely used in the surgical therapy

of colon cancer complicated with intestinal

obstruction patients due to its advantages of

small postoperative wound, less intraopera-

tive blood loss, fewer postoperative compli-

cations, and quick postoperative recovery 9.

The objective of this study was to investigate

further the effect of laparoscopic surgery on

patients with colon cancer complicated with

intestinal obstruction.

MATERIALS AND METHODS

Patients

The clinical data of 100 colon cancer

patients complicated with intestinal ob-

struction who underwent surgical treatment

in our hospital from January 2020 to De-

cember 2022 were retrospectively analyzed.

Based on different surgical methods, the pa-

tients were separated into a control group

(CG) and an observation group (OG), with

50 cases in each group.

Inclusion criteria: (1) Patients diag-

nosed with colon cancer combined with in-

testinal obstruction; (2) The patient had not

received any other treatment before surgery.

Exclusion criteria: (1) Patients with

malignant tumors of other sites; (2) Patients

with abnormal heart, liver and kidney func-

tion; (3) Patients who had received open sur-

gery; (4) Intestinal perforation. No signifi-

cant difference was discovered in baseline

data between the two groups (p>0.05), re-

flecting comparability, as shown in Table 1.

Treatments

Both groups underwent general anes-

thesia before surgery, and artificial pneu-

moperitoneum with a pressure of about 15

mmHg was established. Different surgical

positions were taken according to the differ-

ent locations of the colon cancer tumor and

intestinal obstruction.

The CG received a traditional laparot-

omy. The surgical approach was to make an

incision in the middle of the lower abdomen

of the patient. The incision was made succes-

sively according to subcutaneous tissue lev-

els, and the abdominal tumor and intestinal

obstruction sites were carefully observed to

determine their size, location, and adjacent

tissues, to select the resection method for

resection of the tumor, intestine and lymph

nodes. After resection, the bleeding status

of the patient was checked, and abdominal

cleaning was performed. The surgical in-

cision was sutured layer by layer, and the

drainage tube was placed. After laparotomy,

the patients were treated with routine anti-

infection therapy and fluid rehydration.

The OG was treated with laparoscopic

surgery. Puncture was performed on the left

and right sides below the belly button of the

patient, with a length of about 10 mm. The

laparoscope was placed in the abdomen of the

patient, and the abdominal tumor and intesti-

nal obstruction were observed under the lapa-

roscope. Then, the left and right sides of the

upper abdomen of the patient were selected

for puncture, and a Trocar with a length of

about 5 mm was placed in them. The size,

location, and adjacent tissues of the tumor

Table 1. General data of patients in both groups.

Indicators Control group (n=50) Observation group (n=50) p

Gender (male/female) 30/20 29/21 >0.05

Average age (years) 52.93±8.35* 53.06±8.47* >0.05

TNM stage Stage I 20 21

>0.05

Stage II 25 24

Stage III 5 5

* Mean ± standard deviation. TNM: tumor/node/metastasis.

316 Wu and Ta

Investigación Clínica 66(3): 2025

and intestinal obstruction were determined

under the laparoscope, and the primary and

secondary operation holes were established

according to them. Thus, intestinal adhesion

lysis was performed, the tumor intestines

and lymph nodes were removed, and the ab-

dominal cavity of the patient was rinsed with

normal saline, and the surgical incision was

sutured layer by layer. After laparoscopic sur-

gery, the patients were treated with routine

anti-infection and fluid rehydration.

Observation indicators

(1) Evaluation of clinical effects. Cure:

after treatment, the patient’s clinical symp-

toms and pathological tumor disappeared,

X-ray examination showed no intestinal dila-

tion in the abdomen, incision healing with-

out complications; Improvement: the clini-

cal symptoms were significantly improved,

the lesion and tumor were reduced by more

than half, and the abdominal intestinal ob-

struction was partially relieved by X-ray ex-

amination. Ineffective: those who do not

meet the above criteria or whose disease

worsens. Total effective rate = cure rate +

improvement rate.

(2) Evaluation of surgical indicators.

The operation time, intraoperative blood

loss, recovery time of intestinal function,

time of getting out of bed and hospital stay

of patients were observed and recorded.

(3) Pain score was evaluated using a nu-

merical rating scale (NRS). The total score

was 0-10 points.

(4) Inflammatory factors. 5 mL of fast-

ing peripheral blood was gathered from pa-

tients before and three days after surgery in

the morning, respectively. Serum was collect-

ed after centrifugation, and the serum levels

of TNF-α, IL-6, as well as CRP, were examined

employing double-antibody sandwich enzyme-

linked immunosorbent assay (ELISA).

(5) The occurrence of complications, in-

cluding pulmonary infection, incision infec-

tion, intra-abdominal hemorrhage and anas-

tomotic fistula in both groups was compared.

(6) The postoperative quality of life score

of the two groups was compared, including:

physical function, psychological state, social

communication, as well as self-care ability, 25

points for each item, a total score of 0 ~ 100

points.

Statistical analysis

This experiment was conducted with

SPSS 22.0 statistical analysis software. The

measurement data of normal distribution

were exhibited as (x±sd), and the t-test was

adopted for analysis. The count data were

expressed as a rate (%), and a χ2 test was per-

formed between groups, p<0.05 meant the

difference was statistically significant.

RESULTS

Clinical effect

Table 2 displayed that the total clinical

effect of the OG presented better when com-

paring with the CG (p<0.05).

Surgical indicators in both groups

The operation time, intraoperative

blood loss, recovery time of intestinal func-

tion, time of getting out of bed and hospital

stay of patients in the OG presented shorter

relative to the CG (Table 3).

Table 2. Clinical effect.

Groups N Cure Improvement Ineffective Total effective rate

Control group 50 20 22 8 42 (84.00%)*

Observation group 50 26 23 1 49 (98.00%)

χ2 5.983

p <0.05

* Data expressed as n(%).

Laparoscopic surgery on colon cancer 317

Vol. 66(3): 313 - 321, 2025

Degree of pain

No difference was seen in NRS score

between the two groups before surgery

(p>0.05). After surgery, the NRS score de-

clined in both groups, and that in the OG

was lower when compared with the CG (Ta-

ble 4).

Table 4. Degree of pain.

Group NRS

(Pre-op)

NRS

(Post-op) p*

Control group 6.5 ± 0.9 4.2 ± 0.7 <0.05

Observation group 6.4 ± 1.0 2.7 ± 0.6 <0.05

NRS: numerical rating scale. Data expressed as mean

± standard deviation * t-Student test.

Inflammatory response

No difference was seen in TNF-α, IL-6,

and CRP levels between the two groups be-

fore surgery (p>0.05). After surgery, TNF-α,

IL-6, and CRP levels were increased in both

groups, but those in the OG presented lower

when compared with the CG ( Table 5).

Occurrence of complications

Table 6 displayed that the occurrence

of complications in the OG was lower when

compared with the CG (p<0.05).

Quality of life

After surgery, the quality of life scores, in-

cluding physical function, psychological state,

social communication, as well as self-care abil-

ity in the OG, were higher when compared with

the CG (Table 7).

Table 3. Surgical indicators.

Indicator Control group Observation group p*

Operation time (min) 120.0 ± 13.4* 90.0 ± 11.6 <0.05

Intraoperative blood loss (mL) 300.0 ± 45.3 150.0 ± 30.2 <0.05

Recovery of intestinal function (days) 4.2 ± 0.7 2.8 ± 0.6 <0.05

Time of getting out of bed (days) 2.3 ± 0.5 1.5 ± 0.4 <0.05

Hospital stay (days) 9.6 ± 1.4 6.2 ± 1.0 <0.05

Data expressed as mean±standard deviation *t-Student test.

Table 5. Inflammatory response.

Marker CG Pre-op CG Post-op OG Pre-op OG Post-op p*

TNF-α (pg/mL) 15.3 ± 2.1 35.6 ± 4.5 15.1 ± 2.0 28.4 ± 3.6 <0.05

IL-6 (pg/mL) 24.1 ± 3.2 49.8 ± 5.3 23.9 ± 3.4 36.2 ± 4.0 <0.05

CRP (mg/L) 18.7 ± 2.8 44.2 ± 5.8 18.4 ± 2.9 30.1 ± 4.7 <0.05

CG: Control group, OG: Observation group. Data expressed as mean±standard deviation* t- Student test between

Pre-op and Post-op.

Table 6. Occurrence of complications.

Groups N Pulmonary

infection

Incision

infection

Intra-abdominal

hemorrhage

Anastomotic

fistula

Total incidence

rate

Observation group 50 1 0 1 1 3 (6.00%)*

Control group 50 3 2 3 3 11 (22.00%)

χ2 5.316

p <0.05

*Data expressed as n(%).

318 Wu and Ta

Investigación Clínica 66(3): 2025

DISCUSSION

Intestinal obstruction is one of the most

common clinical complications of colon can-

cer, the cause of which is closely related to

postoperative infection and intestinal adhe-

sion in patients with this condition 9. The

clinical symptoms are often manifested as

abdominal distension, constipation and

vomiting, etc. 10 Because the early symptoms

of intestinal obstruction are not easy to de-

tect, and the development rate after the on-

set of the disease is fast, it has a significant

adverse influence on the survival, quality of

life and postoperative recovery of patients 11.

At present, surgery is usually used in the

clinical therapy of colon cancer complicated

with intestinal obstruction, and the curative

effect is exact; the tumor can be removed

in one time, and the obstruction can be re-

moved in one time 12. Traditional laparotomy

is the leading choice for the clinical therapy

of colon cancer complicated with intestinal

obstruction, which has good therapeutic ef-

fect and can effectively remove the tumor and

relieve the intestinal obstruction of patients

13. However, the traditional open surgery will

leave a large wound and multiple postopera-

tive complications, resulting in a slow postop-

erative recovery 14. Therefore, in the therapy

of colon cancer patients with intestinal ob-

struction, it is imperative to adopt a surgical

treatment with minor postoperative wounds,

fewer postoperative complications, and rapid

postoperative recovery, which not only im-

proves the survival rate of patients but also

promotes their quality of life.

In recent years, minimally invasive sur-

gery has been extensively applied in abdomi-

nal surgery, and laparoscopic surgery, as a

minimally invasive surgery, has been widely

used in clinical treatment for its advantages

of small postoperative wound, less intraop-

erative blood loss, fewer postoperative com-

plications and quick postoperative recovery

15. In treating colon cancer complicated with

intestinal obstruction in patients, laparo-

scopic surgery can be used to observe the

patient’s abdominal cavity through a video

probe 16. At the same time, the magnifica-

tion of laparoscopy can effectively ensure the

surgical field of view, so that the patient’s

lesion area is fully and clearly exposed 17.

Moreover, laparoscopy offers the advantage

of multi-angle exploration, allowing for the

clear exposure of positions that are not read-

ily observable in traditional open surgery,

thereby facilitating detailed and precise sur-

gical operations 18. In addition, laparoscopic

surgery can effectively decrease operation

time, reduce postoperative wounds, and de-

crease intraoperative blood loss and postop-

erative complications, thereby speeding up

the patient’s recovery 19.

Our study indicated that the total clini-

cal effect of the OG was better when com-

pared with the CG. The operation time,

intraoperative blood loss, recovery time of

intestinal function, time of getting out of

bed and hospital stay of patients in the OG

were shorter relative to the CG. The NRS

score declined in both groups, with the OG

presenting lower scores when compared to

the CG. All these outcomes indicated that

the application of laparoscopic surgery

could shorten the length of hospital stay,

reduce the amount of intraoperative blood

loss, alleviate the pain of patients, improve

the efficiency of clinical treatment, and pro-

mote the rehabilitation process of patients

in treating colon cancer complicated with

intestinal obstruction. Consistently, Ruben

Veldkamp et al. 20 have indicated that lapa-

Table 7. Quality of life

Domain Control

group

Observation

group p*

Physical function 17.5 ± 2.0 22.4 ± 1.8 <0.05

Psychological

state

18.2 ± 1.9

23.1 ± 2.1

<0.05

Social

communication

17.9 ± 2.3

22.6 ± 1.7

<0.05

Self-care ability 18.0 ± 2.4 23.2 ± 1.9 <0.05

Data expressed as mean±standard deviation *t-Stu-

dent test.

Laparoscopic surgery on colon cancer 319

Vol. 66(3): 313 - 321, 2025

roscopic colectomy is linked to earlier recov-

ery of bowel function, a lower requirement

for analgesics, and a shorter hospital stay

relative to open colectomy 20.

During surgical trauma, patients would

also activate the inflammatory response and

promote the secretion of inflammatory fac-

tors 21. TNF-α is a pro-inflammatory factor,

which is secreted by mononuclear macro-

phages. IL-6 is a crucial cytokine that regu-

lates intercellular immunity and cooperates

with other cytokines in patients to transmit

an inflammatory response, serving as a key

indicator for evaluating the degree of surgi-

cal trauma in patients 22. CRP is an impor-

tant mediator of acute inflammation. When

patients suffer from surgical trauma, the level

of their pain will be significantly increased,

which dramatically improves the tissue repair

ability of patients 23. However, research in this

field has found that CRP levels in patients

are positively linked to the degree of surgical

trauma 24. Our study indicated that after sur-

gery, TNF-α, IL-6, and CRP levels increased in

both groups. However, those in the OG were

lower when compared with the CG, suggest-

ing that the use of laparoscopic surgery could

inhibit the inflammatory response in colon

cancer patients complicated with intestinal

obstruction. Consistently, it has been report-

ed that the inflammatory response is lower in

laparoscopic rectal surgery when compared

with conventional open surgery 25.

In addition, our study indicated that

the occurrence of complications in the OG

was lower when compared with the CG, and

the quality of life scores, including physical

function, psychological state, social com-

munication, as well as self-care ability in the

OG, were higher when compared with the

CG. All above outcomes indicated that the

application of laparoscopic surgery could

reduce the complications and promote the

quality of life of patients with colon cancer

complicated with intestinal obstruction,

which was in agreement with previous stud-

ies 26. As a conclusion, laparoscopic surgery

significantly impacts the treatment of colon

cancer patients with intestinal obstruction,

effectively reducing patient pain, lowering

inflammatory indicators, minimizing post-

operative complications, and improving the

patient’s quality of life.

Acknowledgements

Not applicable.

Funding

Not applicable.

Ethical considerations

The Medical Ethics Committee of the

Baoji High-tech Hospital approved this work.

Conflict of interests

There are no conflicts of interest in this

study.

ORCID number of authors

• Peihua Wu (PW):

0009-0006-8370-8961

• Zhengquan Ta (ZT):

0009-0004-2759-2672

Author’s contributions

PW was responsible for concepting the

study, collecting, analyzing data, and draft-

ing the manuscript. ZT revised the manu-

script and managed the data.

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