JOURNAL ARTICLE
REVIEW

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

Michele Pisano, Luigi Zorcolo, Cecilia Merli, Stefania Cimbanassi, Elia Poiasina, Marco Ceresoli, Ferdinando Agresta, Niccolò Allievi, Giovanni Bellanova, Federico Coccolini, Claudio Coy, Paola Fugazzola, Carlos Augusto Martinez, Giulia Montori, Ciro Paolillo, Thiago Josè Penachim, Bruno Pereira, Tarcisio Reis, Angelo Restivo, Joao Rezende-Neto, Massimo Sartelli, Massimo Valentino, Fikri M Abu-Zidan, Itamar Ashkenazi, Miklosh Bala, Osvaldo Chiara, Nicola De' Angelis, Simona Deidda, Belinda De Simone, Salomone Di Saverio, Elena Finotti, Inaba Kenji, Ernest Moore, Steven Wexner, Walter Biffl, Raul Coimbra, Angelo Guttadauro, Ari Leppäniemi, Ron Maier, Stefano Magnone, Alain Chicom Mefire, Andrew Peitzmann, Boris Sakakushev, Michael Sugrue, Pierluigi Viale, Dieter Weber, Jeffry Kashuk, Gustavo P Fraga, Ioran Kluger, Fausto Catena, Luca Ansaloni
World Journal of Emergency Surgery: WJES 2018, 13: 36
30123315

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.

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