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Review
. 2019 May 22:14:23.
doi: 10.1186/s13017-019-0242-5. eCollection 2019.

Optimal management of malignant left-sided large bowel obstruction: do international guidelines agree?

Peter John Webster  1 , Joanna Aldoori  2 , Dermot Anthony Burke  1
Affiliations
Review

Optimal management of malignant left-sided large bowel obstruction: do international guidelines agree?

Peter John Webster et al. World J Emerg Surg. .

Abstract

Background: Approximately 20% of patients diagnosed with colorectal cancer will present with left-sided large bowel obstruction. The optimal management of this cohort of patients remains unclear. We aimed to review international guidelines to see if there was a consensus on the treatment of this surgical emergency.

Methods: The PubMed and Medline databases were searched for guidelines on the management of left-sided, malignant large bowel obstruction (MBO) between 2010 and 2018.

Results: Nineteen guidelines were identified spanning a range of continents. There was no clear consensus on the management of potentially resectable disease. Eight guidelines (42%) suggested primary surgery, two guidelines (11%) suggested stenting as a bridge to surgery and nine guidelines (47%) suggested surgery or stenting could be performed. Primary resection with or without anastomosis was the most frequently recommended procedure (n = 6 35%), but over a third of guidelines gave no operative recommendations. There was very limited detail on the stenting procedure and how long elective surgery should be deferred. In the palliative situation, there was general agreement that stents should be offered in preference to surgery.

Conclusion: International guidelines offer limited and contrasting recommendations on the management of left-sided MBO. There is a lack of high-quality evidence to support whether emergency surgery or stenting as a bridge to surgery is the optimal procedure in terms of morbidity, mortality and long-term oncological outcome.

Keywords: Bowel obstruction; Bridge to surgery; Colorectal cancer; Stent.

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Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA diagram of the search strategy
Fig. 2
Fig. 2
Properties of the reviewed guidelines. a Origin of the guidelines. b Context of the guidelines
Fig. 3
Fig. 3
Recommended surgical procedures for the management of left-sided MBO
Fig. 4
Fig. 4
Recommended method of stenting
Fig. 5
Fig. 5
Recommendations for the management of palliative patients with left-sided MBO
See this image and copyright information in PMC

References

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    1. Ansaloni L, Andersson RE, Bazzoli F, et al. Guidelines in the management of obstructing cancer of the left colon: consensus conference of the World Society of Emergency Surgery (WSES) and Peritoneum and Surgery (PnS) society. World J Emerg Surg. 2010;5:29. - PMC - PubMed
    1. Finan PJ, Campbell S, Verma R, et al. The management of malignant large bowel obstruction: ACPGBI position statement. Color Dis. 2007;9(Suppl 4):1–17. - PubMed
    1. Frago R, Ramirez E, Millan M, Kreisler E, del Valle E, Biondo S. Current management of acute malignant large bowel obstruction: a systematic review. Am J Surg. 2014;207(1):127–138. - PubMed
    1. ACPGBI Emergency General Surgery Sub-Committee. Recommendations for the management of large bowel obstruction. ACPGBI 2017. Available at https://www.acpgbi.org.uk/ (Accessed 02/06/2018).

MeSH terms