While surgery must remain the primary treatment for malignant obstruction, it is now recognised that there is a group of patients with advanced disease or poor general condition who are unfit for surgery and require alternative management to relieve distressing symptoms. A number of treatment options are now available for the patient with advanced cancer who develops intestinal obstruction. In this review of the literature, the indications for surgery will be examined, the use of nasogastric tube and percutaneous gastrostomy evaluated and the place of drugs for symptom control described.

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Introduction Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short‐term outcomes of TaTME, open, laparoscopic, and robotic TME internationally. Methods A pre‐planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients undergoing elective total mesorectal excision (TME) for malignancy between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Results Of 2579 included patients, 76.2% (1966/2579) underwent TME with restorative anastomosis of which 19.9% (312/1966) had a minimally invasive approach (laparoscopic or robotic) which included a transanal component (TaTME). Overall, 9.0% (175/1951, 15 missing outcome data) of patients suffered an anastomotic leak. On univariate analysis both laparoscopic TaTME (OR 1.61, 1.02–2.48, P = 0.04) and robotic TaTME (OR 3.05, 1.10–7.34, P = 0.02) were associated with a higher risk of anastomotic leak than non‐transanal laparoscopic TME. However this association was lost in the mixed‐effects model controlling for patient and disease factors (OR 1.23, 0.77–1.97, P = 0.39 and OR 2.11, 0.79–5.62, P = 0.14 respectively), whilst low rectal anastomosis (OR 2.72, 1.55–4.77, P < 0.001) and male gender (OR 2.29, 1.52–3.44, P < 0.001) remained strongly associated. The overall positive circumferential margin resection rate was 4.0%, which varied between operative approaches: laparoscopic 3.2%, transanal 3.8%, open 4.7%, robotic 1%. Conclusion This contemporaneous international snapshot shows that uptake of the TaTME approach is widespread and is associated with surgically and pathologically acceptable results.

The aim of this study was to investigate the short and long term outcomes after elective laparoscopic surgery for colorectal cancer patients over 80 years of age. Methods: This was a retrospective study of all patients of 80 and above, who underwent elective colorectal resection, between January 2007 and January 2016. Data were analysed from a prospectively collected cancer database and cross checked with patient records. Determinants of survival were analysed using log rank test and Kaplan-Meier curves. Results: We identified 293 patients; 110 underwent laparoscopic surgery (LPS). LPS had significantly better overall survival (p=0.0065), disease free survival (p=0.006). The LPS group also had a shorter length of stay-9 vs. 11 days (p<0.00001), 90 day mortality-5.5 vs. 13.7 per cent (p=0.03) and required fewer blood transfusions 22.7 vs.40.4 per cent (p=0.002), when compared to open surgery (OPS). There was no difference in 30 day mortality 1.8 vs. 4.9 per cent (p=0.22), anastomotic leakage 2.3 vs 6 per cent (p=0.20) or post-operative complication rates 44.5 vs. 50.8 per cent (p=0.30). Conclusions: Laparoscopic surgery for patients in their 80s is characterised by better overall and disease free survival compared to open procedures and is associated with shorter postoperative length of stay, and significantly lower 90 day mortality. Patients operated on laparoscopically also required fewer postoperative blood transfusions.