Management of Malignant Colonic Obstruction

Abstract

Malignant large bowel obstruction remains a clinical entity that is commonly encountered despite our advances in screening for colorectal cancer. Patients with malignant large bowel obstruction usually have advanced colorectal cancer and are often poor operative candidates, yet these patients are in need of treatment and colonic decompression. Surgical therapies are available and can offer good outcomes in selected patients. Patients who have curative or palliative surgeries planned should routinely undergo preoperative endoscopic decompression. Available options for decompression include the placement of colonic decompression tubes, ablative methods such as the use of lasers, argon plasma coagulators, and the use of self-expanding metal stents. The author favors the use of self-expanding metal stents, as these devices provide rapid colonic decompression, create a wide luminal diameter, and are applicable in patients requiring preoperative decompression and bowel preparation as well as in patients undergoing palliative therapy only. Patients who go on to surgery can have the stent and tumor removed en bloc at the time of the procedure, whereas patients who are only candidates for palliation can have the stents left in place as permanent decompressive devices with minimal morbidity and mortality.