2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation
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 perf...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-08-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13017-018-0192-3 |
| _version_ | 1828858408256667648 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Michele Pisano |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-13T01:56:01Z |
| format | Article |
| id | doaj.art-0957767f9b2d4d459557af9f784f4347 |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-12-13T01:56:01Z |
| publishDate | 2018-08-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-0957767f9b2d4d459557af9f784f43472022-12-22T00:03:23ZengBMCWorld Journal of Emergency Surgery1749-79222018-08-0113112710.1186/s13017-018-0192-32017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforationMichele Pisano0Luigi Zorcolo1Cecilia Merli2Stefania Cimbanassi3Elia Poiasina4Marco Ceresoli5Ferdinando Agresta6Niccolò Allievi7Giovanni Bellanova8Federico Coccolini9Claudio Coy10Paola Fugazzola11Carlos Augusto Martinez12Giulia Montori13Ciro Paolillo14Thiago Josè Penachim15Bruno Pereira16Tarcisio Reis17Angelo Restivo18Joao Rezende-Neto19Massimo Sartelli20Massimo Valentino21Fikri M. Abu-Zidan22Itamar Ashkenazi23Miklosh Bala24Osvaldo Chiara25Nicola de’ Angelis26Simona Deidda27Belinda De Simone28Salomone Di Saverio29Elena Finotti30Inaba Kenji31Ernest Moore32Steven Wexner33Walter Biffl34Raul Coimbra35Angelo Guttadauro36Ari Leppäniemi37Ron Maier38Stefano Magnone39Alain Chicom Mefire40Andrew Peitzmann41Boris Sakakushev42Michael Sugrue43Pierluigi Viale44Dieter Weber45Jeffry Kashuk46Gustavo P. Fraga47Ioran Kluger48Fausto Catena49Luca Ansaloni50General Surgery Papa Giovanni XXII Hospital BergamoColorectal Unit, Department of Surgery, University of CagliariUnit of Emergency Medicine Ospedale Bufalini Cesena, AUSL RomagnaTrauma TeamGOM NiguardaGeneral Surgery Papa Giovanni XXII Hospital BergamoDepartment of General Surgery, School of Medicine, University of MilanoDepartment of General Surgery ULSS5 del VenetoGeneral Surgery Papa Giovanni XXII Hospital BergamoS.S. Annunziata HospitalUnit of General and Emergency Surgery, Ospedale Bufalini Cesena, AUSL RomagnaColorectal Unit, Campinas State UniversityGeneral Surgery Papa Giovanni XXII Hospital BergamoDivision of Colorectal Surgery, University of CampinasGeneral Surgery ASSTEmergency Department Udine Healthcare and University Integrated TrustCentro Radiológico Campinas, Vera Cruz HospitalDepartment of Surgery, University of CampinasOncology Surgery and Intensive Care, Oswaldo Cruz HospitalColorectal Unit, Department of Surgery, University of CagliariDepartment of Surgery Division of General Surgery, University of TorontoSurgical Department, University of MacerataRadiology Unit Emergency Department, S. Antonio Abate HospitalDepartment of Surgery, College of Medicine and Health Sciences, UAE UniversityHillel Yaffe Medical Center HaderaTrauma and Acute Care Surgery Unit Hadassah, Hebrew University Medical CenterTrauma TeamGOM NiguardaUnit of Digestive Surgery, HPB Surgery and Liver Transplant Henri Mondor HospitalColorectal Unit, Department of Surgery, University of CagliariDepartment of General and Emergency Surgery Cannes’ Hospital CannesCambridge Colorectal Unit, Cambridge University HospitalsDepartment of General Surgery ULSS5 del VenetoDivision of Trauma & Critical Care University of Southern CaliforniaDepartment of Surgery, Denver Health Medical Center, University of ColoradoDigestive Disease Center, Department of Colorectal Surgery Cleveland Clinic FloridaAcute Care Surgery The Queen’s Medical CenterDivision of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego Health SciencesDepartment of General Surgery, School of Medicine, University of MilanoSecond Department of Surgery, Meilahti HospitalDepartment of Surgery, Harborview Medical CentreGeneral Surgery Papa Giovanni XXII Hospital BergamoDepartment of Surgery and Obs/Gyn, Faculty of Health Sciences, University of BueaDepartment of Surgery, Trauma and Surgical Services, University of Pittsburgh School of MedicineGeneral Surgery Department, Medical University, University Hospital St GeorgeGeneral Surgery Department, Letterkenny HospitalInfectious Diseases Unit, Department of Medical and Surgical Sciences, Sant’Orsola Hospital, University of BolognaTrauma and General Surgeon, Royal Perth HospitalSurgery and Critical Care Assuta Medical CentersDivision of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp)Department of General Surgery, Division of Surgery, Rambam Health Care CampusDepartment of Emergency Surgery, Parma Maggiore HospitalUnit of General and Emergency Surgery, Ospedale Bufalini Cesena, AUSL RomagnaAbstract 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.http://link.springer.com/article/10.1186/s13017-018-0192-3ColonRectumCancerObstructionPerforationEmergency |
| spellingShingle | 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 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation World Journal of Emergency Surgery Colon Rectum Cancer Obstruction Perforation Emergency |
| title | 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation |
| title_full | 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation |
| title_fullStr | 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation |
| title_full_unstemmed | 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation |
| title_short | 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation |
| title_sort | 2017 wses guidelines on colon and rectal cancer emergencies obstruction and perforation |
| topic | Colon Rectum Cancer Obstruction Perforation Emergency |
| url | http://link.springer.com/article/10.1186/s13017-018-0192-3 |
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