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Review
. 2018 Aug 13:13:36.
doi: 10.1186/s13017-018-0192-3. eCollection 2018.

2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation

Michele Pisano  1 , Luigi Zorcolo  2 , Cecilia Merli  3 , Stefania Cimbanassi  4 , Elia Poiasina  1 , Marco Ceresoli  5 , Ferdinando Agresta  6 , Niccolò Allievi  1 , Giovanni Bellanova  7 , Federico Coccolini  8 , Claudio Coy  9 , Paola Fugazzola  1 , Carlos Augusto Martinez  10 , Giulia Montori  11 , Ciro Paolillo  12 , Thiago Josè Penachim  13 , Bruno Pereira  14 , Tarcisio Reis  15 , Angelo Restivo  2 , Joao Rezende-Neto  16 , Massimo Sartelli  17 , Massimo Valentino  18 , Fikri M Abu-Zidan  19 , Itamar Ashkenazi  20 , Miklosh Bala  21 , Osvaldo Chiara  4 , Nicola De' Angelis  22 , Simona Deidda  2 , Belinda De Simone  23 , Salomone Di Saverio  24 , Elena Finotti  6 , Inaba Kenji  25 , Ernest Moore  26 , Steven Wexner  27 , Walter Biffl  28 , Raul Coimbra  29 , Angelo Guttadauro  5 , Ari Leppäniemi  30 , Ron Maier  31 , Stefano Magnone  1 , Alain Chicom Mefire  32 , Andrew Peitzmann  33 , Boris Sakakushev  34 , Michael Sugrue  35 , Pierluigi Viale  36 , Dieter Weber  37 , Jeffry Kashuk  38 , Gustavo P Fraga  39 , Ioran Kluger  40 , Fausto Catena  41 , Luca Ansaloni  8
Affiliations
Review

2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation

Michele Pisano et al. World J Emerg Surg. .

Abstract

ᅟ: Obstruction and perforation due to colorectal cancer represent challenging matters in terms of diagnosis, life-saving strategies, obstruction resolution and oncologic challenge. The aims of the current paper are to update the previous WSES guidelines for the management of large bowel perforation and obstructive left colon carcinoma (OLCC) and to develop new guidelines on obstructive right colon carcinoma (ORCC).

Methods: The literature was extensively queried for focused publication until December 2017. Precise analysis and grading of the literature has been performed by a working group formed by a pool of experts: the statements and literature review were presented, discussed and voted at the Consensus Conference of the 4th Congress of the World Society of Emergency Surgery (WSES) held in Campinas in May 2017.

Results: CT scan is the best imaging technique to evaluate large bowel obstruction and perforation. For OLCC, self-expandable metallic stent (SEMS), when available, offers interesting advantages as compared to emergency surgery; however, the positioning of SEMS for surgically treatable causes carries some long-term oncologic disadvantages, which are still under analysis. In the context of emergency surgery, resection and primary anastomosis (RPA) is preferable to Hartmann's procedure, whenever the characteristics of the patient and the surgeon are permissive. Right-sided loop colostomy is preferable in rectal cancer, when preoperative therapies are predicted.With regards to the treatment of ORCC, right colectomy represents the procedure of choice; alternatives, such as internal bypass and loop ileostomy, are of limited value.Clinical scenarios in the case of perforation might be dramatic, especially in case of free faecal peritonitis. The importance of an appropriate balance between life-saving surgical procedures and respect of oncologic caveats must be stressed. In selected cases, a damage control approach may be required.Medical treatments including appropriate fluid resuscitation, early antibiotic treatment and management of co-existing medical conditions according to international guidelines must be delivered to all patients at presentation.

Conclusions: The current guidelines offer an extensive overview of available evidence and a qualitative consensus regarding management of large bowel obstruction and perforation due to colorectal cancer.

Keywords: Cancer; Colon; Emergency; Obstruction; Perforation; Rectum.

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Conflict of interest statement

Not applicable. Not applicable. The authors declare that they have no competing interests. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Cumulative diagram for the three items (confirmation, cause, site of LBO) according to imaging study. US ultrasound, CT computerized tomography
Fig. 2
Fig. 2
Flowchart for the management of colonic perforation due to colorectal cancer
Fig. 3
Fig. 3
Flowchart for the management of colonic obstruction due to colorectal cancer
See this image and copyright information in PMC

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