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World J Emerg Surg. 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.

Author information

1
General Surgery Papa Giovanni XXII Hospital Bergamo, Bergamo, Italy.
2
2Colorectal Unit, Department of Surgery, University of Cagliari, Cagliari, Italy.
3
Unit of Emergency Medicine Ospedale Bufalini Cesena, AUSL Romagna, Romagna, Italy.
4
Trauma TeamGOM Niguarda, Milan, Italy.
5
5Department of General Surgery, School of Medicine, University of Milano, Milan, Italy.
6
Department of General Surgery ULSS5 del Veneto, Adria, (RO) Italy.
7
S.S. Annunziata Hospital, Taranto, Italy.
8
Unit of General and Emergency Surgery, Ospedale Bufalini Cesena, AUSL Romagna, Romagna, Italy.
9
9Colorectal Unit, Campinas State University, Campinas, SP Brazil.
10
10Division of Colorectal Surgery, University of Campinas, Campinas, SP Brazil.
11
General Surgery ASST, Bergamo, Italy.
12
Emergency Department Udine Healthcare and University Integrated Trust, Udine, Italy.
13
Centro Radiológico Campinas, Vera Cruz Hospital, São Paulo, Brazil.
14
14Department of Surgery, University of Campinas, Campinas, Brazil.
15
Oncology Surgery and Intensive Care, Oswaldo Cruz Hospital, Recife, Brazil.
16
16Department of Surgery Division of General Surgery, University of Toronto, Toronto, Canada.
17
17Surgical Department, University of Macerata, Macerata, Italy.
18
18Radiology Unit Emergency Department, S. Antonio Abate Hospital, Tolmezzo, UD Italy.
19
19Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
20
20Hillel Yaffe Medical Center Hadera, Hadera, Israel.
21
21Trauma and Acute Care Surgery Unit Hadassah, Hebrew University Medical Center, Jerusalem, Israel.
22
22Unit of Digestive Surgery, HPB Surgery and Liver Transplant Henri Mondor Hospital, Créteil, France.
23
Department of General and Emergency Surgery Cannes' Hospital Cannes, Cedex, Cannes, France.
24
24Cambridge Colorectal Unit, Cambridge University Hospitals, Cambridge, UK.
25
25Division of Trauma & Critical Care University of Southern California, Los Angeles, USA.
26
26Department of Surgery, Denver Health Medical Center, University of Colorado, Denver, CO USA.
27
Digestive Disease Center, Department of Colorectal Surgery Cleveland Clinic Florida, Tallahassee, USA.
28
28Acute Care Surgery The Queen's Medical Center, Honolulu, HI USA.
29
29Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego Health Sciences, San Diego, USA.
30
Second Department of Surgery, Meilahti Hospital, Helsinki, Finland.
31
Department of Surgery, Harborview Medical Centre, Seattle, USA.
32
32Department of Surgery and Obs/Gyn, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
33
33Department of Surgery, Trauma and Surgical Services, University of Pittsburgh School of Medicine, Pittsburgh, USA.
34
34General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria.
35
General Surgery Department, Letterkenny Hospital, Letterkenny, Ireland.
36
Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola Hospital, University of Bologna, Bologna, Italy.
37
37Trauma and General Surgeon, Royal Perth Hospital, Perth, Australia.
38
38Surgery and Critical Care Assuta Medical Centers, Tel Aviv, Israel.
39
39Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil.
40
40Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel.
41
Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy.

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

PMID:
30123315
PMCID:
PMC6090779
DOI:
10.1186/s13017-018-0192-3
[Indexed for MEDLINE]
Free PMC Article

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