Role of Exploratory Laparoscopy in the Management of Locally Advanced Colorectal Cancer: A Retrospective Observational Study from Ibn Rochd University Hospital in Casablanca

Abstract

This retrospective study meticulously assessed the pivotal role of exploratory laparoscopy in the staging and therapeutic decision-making processes for locally advanced colorectal cancer (CRC) at Ibn Rochd University Hospital in Casablanca, Morocco. Conducted between January 2018 and December 2023, the study included 24 patients with histologically confirmed advanced CRC who underwent exploratory laparoscopy as part of their management strategy. This minimally invasive procedure demonstrated a significant diagnostic advantage by identifying peritoneal carcinomatosis in 54.4% of patients—lesions that were frequently undetected by preoperative computed tomography (CT) and magnetic resonance imaging (MRI). Notably, in 41% of cases, the intraoperative findings provided by laparoscopy prompted a substantial change in therapeutic plans, including a shift from curative to palliative intent in patients with previously unrecognized carcinomatosis or extensive disease. Such findings underscore laparoscopy’s unique role in bridging the gap between conventional imaging limitations and the need for accurate staging to inform treatment decisions. Beyond its diagnostic superiority, laparoscopy also played a crucial role in avoiding unnecessary laparotomies in patients whose disease burden was deemed too advanced for curative resection, thereby minimizing surgical morbidity and optimizing the allocation of limited healthcare resources. In addition, laparoscopic interventions included biopsies of suspicious lesions, peritoneal lavage, and the creation of diverting colostomies in selected patients to alleviate bowel obstruction and improve quality of life in palliative settings. These collective benefits highlight laparoscopy as a valuable adjunct to standard imaging modalities, particularly in resource-limited environments where access to advanced diagnostic resources is constrained. Despite these promising outcomes and their alignment with existing global literature, the study’s retrospective nature, modest sample size, and absence of a control group limit the generalizability of its conclusions. Therefore, future prospective, multicenter studies are essential to confirm these preliminary findings, establish standardized protocols for laparoscopy’s use in advanced CRC, and delineate patient subgroups that stand to benefit most from this minimally invasive approach. Such efforts will ensure that laparoscopy is optimally integrated into comprehensive, evidence-based treatment strategies for CRC, ultimately improving patient outcomes and supporting health equity in diverse clinical environments.