Treatment of obstructive colorectal carcinoma

Yusuf Yagmur

《Edorium Journal of Surgery》 2期 (2015/12) Pp. 21-25

https://doi.org/10.5348/S05-2015-8-RA-6

並列摘要

Aims: Treatment of obstructive colorectal carcinoma is confronting issue for surgeon. The paper aims to generate evidenced based recommendations on management of obstructive colorectal carcinoma. Methods: The PubMed was queried for publications focusing on obstructive colorectal carcinoma published prior to April 2015. Total 26 studies were investigated. Results: While in the right site colon carcinoma obstruction, resection and anastomosis is almost accepted by all surgeons, left colon carcinoma obstruction is a challenging issue. Several options are available. There was one guideline for obstructing left colorectal cancer prepared at consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society 2010 held in Bologna. In the treatments of obstructive left colon cancer Hartmann's procedure should be preferred to stage processing due to long period of hospitalization and multiple operations with a colostomy. The staged procedure could be preferred in clinical situations like damage control surgery of trauma, neoadjuvant treatment and unresectable disease. Hartmann's procedure is easy with no risk of anastomotic separation and should be preferred by less experienced surgeons in colon surgery. Segmental resection with intra colonic irrigation was accepted more appropriate than subtotal colectomy only in patients with carcinomas of the rectosigmoid junction. Total/ subtotal colectomy (without cecal perforation or synchronous right colon cancer patients) should not be preferred to intra colonic irrigation and segmental colectomy. Results showed no significant difference in the anastomotic leak rates and mortality rates between the intra colonic irrigation and manual decompression in the randomized and comparative trials. Selfexpanding endoscopic metallic (SEMS) was used for palliation and bridge to surgery. The SEMS could be used before elective surgery as bridge to surgery. The SEMS usage has lower mortality, shorter hospital stay and less need for colostomy. In obstructive colorectal cancer, SEMS could be preferred to emergency surgery for palliation with less mortality and morbidity and shorter hospital stay. Conclusion: Onestage resection and ileocolic anastomosis is treatment of choice in case of right colon tumor obstruction. In the treatment of left colon cancer obstruction, Hartmann's procedure seems to be better than staged resection. In case of cecal perforation or ischemia, subtotal and total colectomy is operation of choice. In selected cases, primary resection and anastomosis with manual decompression or intraoperative colonic irrigation could be preferred but diverting loop ileostomy should be added to operation due to risk of anastomotic dehiscence. Colonic stents seems to be good choice in bridge to surgery.

並列關鍵字

Colorectal cancer obstruction ； Left ； Right ； Systematic review