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

Pisano, Michele; Zorcolo, Luigi; Merli, Cecilia; Cimbanassi, Stefania; Poiasina, Elia; Ceresoli, Marco; Agresta, Ferdinando; Allievi, Niccolò; Bellanova, Giovanni; Catena, Fausto; Coy, Cláudio Saddy Rodrigues; Fugazzola, Paola; Martinez, Carlos Augusto Real; Montori, Giulia; Paolillo, Ciro; Penachim, Thiago José; Pereira, Bruno M.; Reis, Tarcisio; Restivo, Angelo; Rezende-Neto, João; Sartelli, Massimo; Valentino, Massimo; Abu‐Zidan, Fikri M.; Ashkenazi, Itamar; Bala, Miklosh; Chiara, Osvaldo; Angelis, Nicola De; Deidda, Simona; Simone, Belinda De; Saverio, Salomone Di; Finotti, Elena; Inaba, Kenji; Moore, Ernest E.; Wexner, Steven D.; Biffl, Walter L.; Coimbra, Raúl; Guttadauro, Angelo; Leppäniemi, Ari; Maier, Ron; Magnone, Stefano; Mefire, Alain Chicom; Peitzmann, Andrew; Sakakushev, Boris; Sugrue, Michael; Viale, Pierluigi; Weber, Dieter; Kashuk, Jeffry L.; Fraga, Gustavo Pereira; Kluger, Ioran; Catena, Fausto; Ansaloni, Luca

doi:10.1186/s13017-018-0192-3

Cited by 246 publications

(243 citation statements)

References 210 publications

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“…The World Society of Emergency Surgery renewed the guidelines on colon and rectal cancer emergencies and concluded that for obstructive left colon carcinoma, SEMS, when available, offers interesting advantages as compared to emergency surgery; however, the positioning of SEMS in surgically treatable cases is still accompanied by some longterm oncologic disadvantages, which are still under analysis 42) , and a "non-inferiority" RCT with survival as primary end point would be the appropriate method to correctly investigate long-term outcomes after stenting as BTS versus emergency surgery.…”

Section: Long-term Outcomes Of Colonic Stentsmentioning

confidence: 99%

Current status of colonic stent for obstructive colorectal cancer in Japan; a review of the literature

Saida

2019

J Anus Rectum Colon

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Colorectal cancer is the most common cancer in Japan. Approximately 10%-20% of the patients with colorectal cancer present with large bowel obstruction, and those who present with malignant colonic obstruction (MCO) require urgent decompression because MCO can cause electrolytic fluid imbalance, colonic necrosis, bacterial translocation, and death. Placement of colonic stents (self-expandable metallic stents) for MCO is a major and standard endoscopic treatment that has been available since 2012 in Japan. This review presents the current conditions and future prospects of this procedure based on the literature. The current indication of colonic stent placement is malignant colorectal stenosis. One of the purposes of using stents is palliative treatment; further, its advantages over emergency surgery with colostomy include avoidance of colostomy, relief of obstruction, shorter hospitalization, and better quality of life. In addition, stent placement can also be used as a bridge to surgery since the duration of the hospitalization is shorter and postoperative complications, colostomy rates, and mortality rates are lower with elective than with emergency surgery. Although recent studies have reported low complication rates related to colonic stents, complications may still occur, highlighting the importance of good preparation, adequate staffing, backup systems, and informed consent. The current major problem related to colonic stents is the lack of evidence on patients' long-term prognoses for bridge to surgery purposes, awaiting the results of ongoing clinical research.

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Section: Long-term Outcomes Of Colonic Stentsmentioning

confidence: 99%

Current status of colonic stent for obstructive colorectal cancer in Japan; a review of the literature

Saida

2019

J Anus Rectum Colon

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“…The latest edition of the World Emergency Surgery Guidelines also stated the obvious advantages of SEMS compared with ES in the treatment of palliative CRC complicated with intestinal obstruction. In patients with curable tumours complicated with obstruction, some patients can be selected when appropriate [19].…”

Section: Discussionmentioning

confidence: 99%

Colon metal stents as a bridge to surgery had no significant effects on the perineural invasion: a retrospective study

et al. 2020

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Purpose: The long-term oncological effects of self-expandable metallic stent (SEMS) as a "bridge to surgery" are contradictory, and perineural invasion was supposed to be enhanced by the stenting. In this retrospective study, we compared the perineural invasion and the oncological outcomes between the stent as a bridge to surgery (SBTS)-and emergency surgery (ES)-treated patients to evaluate the results of stenting on the perineural invasion. Methods: The clinical data of patients with acute intestinal obstruction caused by colorectal cancer from January 2013 to January 2017 were retrospectively collected. Forty-three patients underwent semi-elective curative resection after endoscopic SEMS insertion, and sixty-three underwent ES. The adverse events and long-term follow-up outcomes were assessed. The clinicopathological characteristics, perineural invasion rates, and survival rates were compared between the two patient groups. Results: Stent insertion resulted in significantly lower stoma rate (32.6% vs 46%; P = 0.03), post-operative overall complication rate (11.6% vs 28.6%, P = 0.038), and total hospital stay (17.07 ± 5.544 days vs 20.48 ± 7.372 days, P = 0.042). Compared with the ES group, there was no significant increase in the incidence of peripheral invasion in the SBTS group (39.5% vs 47.6%, P = 0.411). No significant difference was noted in the survival rate and long-term prognosis between the SEMS and ES groups (P = 0.964). The technical success rate was 95.6%, and the clinical success rate was 97.7%. Conclusions: Preoperative colon stenting was an effective transitional method for colorectal cancer patients with complete obstruction. Short-term stent implantation had no significant effect on perineural invasion in patients with CRC.

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“…The Surgeon's and anesthetist's clinical standpoint So far, the clinical management of obstruction of the colon and rectum due to CRC is challenging from a diagnostic and therapeutic standpoint and for the management of septic and oncologic complications [5]. Indeed, few studies had compared theoretical options, mainly dealing with ORCC, since right colectomy and primary anastomosis is considered the best treatment option for ORCC, with a one-step surgical strategy that is generally considered feasible and safe [5].…”

Section: Discussionmentioning

confidence: 99%

“…The patient was diagnosed with an ileus caused by stenosing ascending colon cancer with abnormal distension of the right colon at higher visceral risk of perforation. The patient was asked for consent for the emergency surgery consisting of right colectomy and primary anastomosis, as recommended in the current guidelines [5]. However, the patient refused to give his informed consent for surgery and, as an alternative surgical procedure, a lateral decompressive cecostomy without one-stage primary tumor resection during emergency operation was performed in local anesthesia (operating time about 25 min), minimizing the risk for colon perforation with preoperative blood transfusion and intravenous fluid replacement.…”

Section: Case Presentationmentioning

confidence: 99%

A two-step surgery and a multidisciplinary approach in a centenarian patient with an acute presentation of right colon cancer

et al. 2020

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Background: As surgery remains the cornerstone of colorectal cancer (CRC) treatment, the number of older patients presented for colorectal resection is rapidly increasing. Nevertheless, the choice to operate an oldest-old patient still remain challenging and requires a careful assessment of risk to benefit ratio in order to guarantee appropriate surgical strategies and perioperative management. Case presentation: A centenarian patient, acutely admitted to the emergency department, was diagnosed with an ileus caused by stenosing ascending colon cancer with abnormal distension of the right colon at high risk of perforation. Facing with this complex clinical scenario, a lateral decompressive cecostomy as alternative surgical procedure, was performed in local anesthesia in order to avoid the stressful event of an emergency surgery. Thereafter, the patient was admitted to the surgical ward and followed by a geriatrician who performed a comprehensive geriatric assessment (CGA) and daily clinical evaluations. This integrated plan of care was mainly focused on rehabilitation, nutritional interventions and therapeutic reconciliation, maximizing patient's clinical conditions and performance status. Then, the second surgical step, the radical colon surgery with curative intent and bowel continuity reestablishment was performed, demonstrating to be feasible and safety also in a very advanced age patient in term of prolonged survival and preservation of an adequate quality of life. Conclusions: This is the first case-report that illustrates a successful two step surgery for CRC in a centenarian patient thanks to a multidisciplinary based approach, overwhelming the mere concept of chronological age.

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

Cited by 246 publications

References 210 publications

Current status of colonic stent for obstructive colorectal cancer in Japan; a review of the literature

Current status of colonic stent for obstructive colorectal cancer in Japan; a review of the literature

Colon metal stents as a bridge to surgery had no significant effects on the perineural invasion: a retrospective study

A two-step surgery and a multidisciplinary approach in a centenarian patient with an acute presentation of right colon cancer

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