Evidence-Based Current Surgical Practice
Urgent Management of Obstructing Colorectal Cancer: Divert, Stent, or Resect?

https://doi.org/10.1007/s11605-018-3990-8Get rights and content

Abstract

Despite the availability of effective colorectal cancer (CRC) screening strategies, up to 10% of CRC patients present with obstructive symptoms as the first sign of disease. For patients with acute or subacute malignant obstruction that requires urgent intervention, treatment options include endoscopic stenting as a bridge to surgery, one-stage surgical resection and anastomosis, or diverting ostomy which may or may not be followed by later tumor resection and stoma closure. However, to date, there is no consensus guideline for the optimal approach to manage malignant colorectal obstruction. This article aims to illustrate clinical scenarios in palliative, curative, and potentially curative settings, and delineate the key factors to be considered when making an individualized decision in order to determine the optimal treatment.

Keywords

Colorectal cancer
Malignant obstruction
Emergency surgery
Diverting ostomy
Stent

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Disclosure Information

Authors: Songphol Malakorn, MD, has nothing to disclose; Sharon L. Stein, MD, has nothing to disclose; Jeffrey H. Lee, MD, has nothing to disclose; Y. Nancy You, MD, MHSc, has nothing to disclose. Editors-in-Chief: Richard A. Hodin, MD, and Timothy M. Pawlik, MD, MPH, PhD, have nothing to disclose. CME Overseers: Arbiter: Timothy M. Pawlik, MD, MPH, PhD, has nothing to disclose; Vice-Arbiter: Melanie Morris, MD, has nothing to disclose; Question Reviewers: F. Andrew Morfesis, MD, has nothing to disclose; Iswanto Sucandy, MD, has nothing to disclose.

CME questions for this article are available to SSAT members at http://ssat.com/jogscme/.

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Copyright © 2018 Society for Surgery of the Alimentary Tract. Published by ELSEVIER INC. All rights reserved. Published by Elsevier Inc. All rights reserved.