Advertisement

Emergencies Related to Primary Colon Cancer: Multidisciplinary Management of Colon Obstruction, Perforation and Bleeding Due to Colon Cancer in the Absence of Metastatic Disease

  • Erika Picariello
  • Claudia Zaghi
  • Paola Fugazzola
  • Matteo Tomasoni
  • Enrico Cicuttin
  • Luca Ansaloni
  • Federico Coccolini
Chapter
Part of the Hot Topics in Acute Care Surgery and Trauma book series (HTACST)

Abstract

Occlusion, perforation, and bleeding are a common presentation of colorectal cancer in the acute setting and are a challenging matter in terms of diagnosis, life-saving strategies, and oncological issues. The challenge is to combine the oncological skills and the acute care surgery expertise (in the urgent surgical theater).

The aim is to underline the clinical presentation, the diagnosis, and the treatment of colorectal cancer in emergency settings.

Keywords

Colorectal cancer Occlusion Perforation Bleeding Emergency 

Abbreviations

CRC

Colorectal cancer

CT scan

Computed tomography

DC

Damage control

HP

Hartmann procedure

LBO

Large bowel obstruction

LCO

Left colon obstruction

OLCC

Obstructed left colon cancer

ORCC

Obstructed right colon cancer

RC

Right colectomy

RPA

Resection and primary anastomosis

SEMS

Self-expanding metallic stents

TD

Tube decompression

References

  1. 1.
    Arnold M, et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66(4):683–91.CrossRefGoogle Scholar
  2. 2.
    Torre LA, et al. Global cancer incidence and mortality rates and trends--an update. Cancer Epidemiol Biomarkers Prev. 2016;25(1):16–27.CrossRefGoogle Scholar
  3. 3.
    Zielinski MD, et al. Emergency management of perforated colon cancers: how aggressive should we be? J Gastrointest Surg. 2011;15(12):2232–8.CrossRefGoogle Scholar
  4. 4.
    Alvarez JA, et al. Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma. Am J Surg. 2005;190(3):376–82.CrossRefGoogle Scholar
  5. 5.
    Gunnarsson H, et al. Emergency presentation of colon cancer is most frequent during summer. Colorectal Dis. 2011;13(6):663–8.CrossRefGoogle Scholar
  6. 6.
    Barnett A, et al. Colorectal cancer emergencies. J Gastrointest Cancer. 2013;44(2):132–42.CrossRefGoogle Scholar
  7. 7.
    Laine L, et al. Trends for incidence of hospitalization and death due to GI complications in the United States from 2001 to 2009. Am J Gastroenterol. 2012;107(8):1190–5. quiz 1196.CrossRefGoogle Scholar
  8. 8.
    Pereira J, et al. Management of bleeding in patients with advanced cancer. Oncologist. 2004;9(5):561–70.CrossRefGoogle Scholar
  9. 9.
    Frago R, et al. Current management of acute malignant large bowel obstruction: a systematic review. Am J Surg. 2014;207(1):127–38.CrossRefGoogle Scholar
  10. 10.
    Biondo S, et al. Differences in patient postoperative and long-term outcomes between obstructive and perforated colonic cancer. Am J Surg. 2008;195(4):427–32.CrossRefGoogle Scholar
  11. 11.
    Anwar MA, et al. Outcome of acutely perforated colorectal cancers: experience of a single district general hospital. Surg Oncol. 2006;15(2):91–6.CrossRefGoogle Scholar
  12. 12.
    Markogiannakis H, et al. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World J Gastroenterol. 2007;13(3):432–7.CrossRefGoogle Scholar
  13. 13.
    Cappell MS, Batke M. Mechanical obstruction of the small bowel and colon. Med Clin North Am. 2008;92(3):575–97. viii.CrossRefGoogle Scholar
  14. 14.
    Lopez-Kostner F, Hool GR, Lavery IC. Management and causes of acute large-bowel obstruction. Surg Clin North Am. 1997;77(6):1265–90.CrossRefGoogle Scholar
  15. 15.
    Kahi CJ, Rex DK. Bowel obstruction and pseudo-obstruction. Gastroenterol Clin North Am. 2003;32(4):1229–47.CrossRefGoogle Scholar
  16. 16.
    Marion Y, et al. The management of lower gastrointestinal bleeding. J Visc Surg. 2014;151(3):191–201.CrossRefGoogle Scholar
  17. 17.
    Shelton BK. Intestinal obstruction. AACN Clin Issues. 1999;10(4):478–91.CrossRefGoogle Scholar
  18. 18.
    Suri S, et al. Comparative evaluation of plain films, ultrasound and CT in the diagnosis of intestinal obstruction. Acta Radiol. 1999;40(4):422–8.CrossRefGoogle Scholar
  19. 19.
    Frager D, et al. Prospective evaluation of colonic obstruction with computed tomography. Abdom Imaging. 1998;23(2):141–6.CrossRefGoogle Scholar
  20. 20.
    Finan PJ, Campbell S, et al. The management of malignant large bowel obstruction: ACPGBI position statement. Colorectal Dis. 2007;9(Supp 4):17.Google Scholar
  21. 21.
    Gainant A, et al. Emergency management of acute colonic cancer obstruction. J Visc Surg. 2012;149(1):e3–e10.CrossRefGoogle Scholar
  22. 22.
    Chen SC, et al. Ultrasonography is superior to plain radiography in the diagnosis of pneumoperitoneum. Br J Surg. 2002;89(3):351–4.CrossRefGoogle Scholar
  23. 23.
    Mularski RA, Sippel JM, Osborne ML. Pneumoperitoneum: a review of nonsurgical causes. Crit Care Med. 2000;28(7):2638–44.CrossRefGoogle Scholar
  24. 24.
    Tang A, et al. Clinical cases of nonsurgical pneumoperitoneum: categorizing the disease and treatment options. Am Surg. 2015;81(5):E206–8.PubMedGoogle Scholar
  25. 25.
    Werner DJ, et al. Endoscopic and angiographic management of lower gastrointestinal bleeding: review of the published literature. United Eur Gastroenterol J. 2018;6(3):337–42.CrossRefGoogle Scholar
  26. 26.
    Nusbaum S, Baum S. Radiographic demonstration of unknown sites of gastrointestinal bleeding. Surg Forum. 1963;14:374–5.PubMedGoogle Scholar
  27. 27.
    De Salvo GL, Gava C, Pucciarelli S, Lise M. Curative surgery for obstruction from primary left colorectal carcinoma: primary or staged resection? Cochrane Database Syst Rev. 2004;(2):CD002101.Google Scholar
  28. 28.
    Krstic S, et al. Hartmann’s procedure vs loop colostomy in the treatment of obstructive rectosigmoid cancer. World J Emerg Surg. 2014;9(1):52.CrossRefGoogle Scholar
  29. 29.
    Fielding LP, Stewart-Brown S, Blesovsky L. Large-bowel obstruction caused by cancer: a prospective study. Br Med J. 1979;2(6189):515–7.CrossRefGoogle Scholar
  30. 30.
    Kube R, et al. Surgical practices for malignant left colonic obstruction in Germany. Eur J Surg Oncol. 2010;36(1):65–71.CrossRefGoogle Scholar
  31. 31.
    Trompetas V. Emergency management of malignant acute left-sided colonic obstruction. Ann R Coll Surg Engl. 2008;90(3):181–6.CrossRefGoogle Scholar
  32. 32.
    Meyer F, et al. Emergency operation in carcinomas of the left colon: value of Hartmann’s procedure. Tech Coloproctol. 2004;8(Suppl 1):s226–9.CrossRefGoogle Scholar
  33. 33.
    Alves A, et al. Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study. Arch Surg. 2005;140(3):278–83. discussion 284.CrossRefGoogle Scholar
  34. 34.
    Ballian N, et al. Comparable postoperative morbidity and mortality after laparoscopic and open emergent restorative colectomy: outcomes from the ACS NSQIP. World J Surg. 2012;36(10):2488–96.CrossRefGoogle Scholar
  35. 35.
    Araki Y, et al. Endoscopic decompression procedure in acute obstructing colorectal cancer. Endoscopy. 2000;32(8):641–3.CrossRefGoogle Scholar
  36. 36.
    Harris GJ, et al. The management of neoplastic colorectal obstruction with colonic endolumenal stenting devices. Am J Surg. 2001;181(6):499–506.CrossRefGoogle Scholar
  37. 37.
    Zhang Y, et al. Self-expanding metallic stent as a bridge to surgery versus emergency surgery for obstructive colorectal cancer: a meta-analysis. Surg Endosc. 2012;26(1):110–9.CrossRefGoogle Scholar
  38. 38.
    Cennamo V, et al. Does stent placement for advanced colon cancer increase the risk of perforation during bevacizumab-based therapy? Clin Gastroenterol Hepatol. 2009;7(11):1174–6.CrossRefGoogle Scholar
  39. 39.
    Manes G, et al. Endoscopic palliation in patients with incurable malignant colorectal obstruction by means of self-expanding metal stent: analysis of results and predictors of outcomes in a large multicenter series. Arch Surg. 2011;146(10):1157–62.CrossRefGoogle Scholar
  40. 40.
    Faucheron JL, et al. Emergency surgery for obstructing colonic cancer: a comparison between right-sided and left-sided lesions. Eur J Trauma Emerg Surg. 2018;44(1):71–7.CrossRefGoogle Scholar
  41. 41.
    Chang GJ, et al. Practice parameters for the management of colon cancer. Dis Colon Rectum. 2012;55(8):831–43.CrossRefGoogle Scholar
  42. 42.
    Amelung FJ, et al. Emergency resection versus bridge to surgery with stenting in patients with acute right-sided colonic obstruction: a systematic review focusing on mortality and morbidity rates. Int J Colorectal Dis. 2015;30(9):1147–55.CrossRefGoogle Scholar
  43. 43.
    Mazuski JE, et al. The surgical infection society revised guidelines on the management of intra-abdominal infection. Surg Infect (Larchmt). 2017;18(1):1–76.CrossRefGoogle Scholar
  44. 44.
    Sartelli M, et al. Management of intra-abdominal infections: recommendations by the WSES 2016 consensus conference. World J Emerg Surg. 2017;12:22.CrossRefGoogle Scholar
  45. 45.
    Honore C, et al. Definition of patients presenting a high risk of developing peritoneal carcinomatosis after curative surgery for colorectal cancer: a systematic review. Ann Surg Oncol. 2013;20(1):183–92.CrossRefGoogle Scholar
  46. 46.
    Strate LL, Gralnek IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol. 2016;111(4):459–74.CrossRefGoogle Scholar
  47. 47.
    Person B, et al. Abbreviated emergency laparotomy in the non-trauma setting. World J Emerg Surg. 2009;4:41.CrossRefGoogle Scholar
  48. 48.
    Weber DG, Bendinelli C, Balogh ZJ. Damage control surgery for abdominal emergencies. Br J Surg. 2014;101(1):e109–18.CrossRefGoogle Scholar
  49. 49.
    Becher RD, et al. Damage control operations in non-trauma patients: defining criteria for the staged rapid source control laparotomy in emergency general surgery. World J Emerg Surg. 2016;11:10.CrossRefGoogle Scholar
  50. 50.
    Kaya E, et al. Predictor of poor outcome in gastrointestinal bleeding in emergency department. World J Gastroenterol. 2016;22(16):4219–25.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Erika Picariello
    • 1
  • Claudia Zaghi
    • 1
  • Paola Fugazzola
    • 1
  • Matteo Tomasoni
    • 1
  • Enrico Cicuttin
    • 1
  • Luca Ansaloni
    • 1
  • Federico Coccolini
    • 1
  1. 1.General, Emergency and Trauma Surgery DepartmentBufalini HospitalCesenaItaly

Personalised recommendations