World Journal of Emergency Surgery (Aug 2018)
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
Affiliations
- Michele Pisano
- General Surgery Papa Giovanni XXII Hospital Bergamo
- Luigi Zorcolo
- Colorectal Unit, Department of Surgery, University of Cagliari
- Cecilia Merli
- Unit of Emergency Medicine Ospedale Bufalini Cesena, AUSL Romagna
- Stefania Cimbanassi
- Trauma TeamGOM Niguarda
- Elia Poiasina
- General Surgery Papa Giovanni XXII Hospital Bergamo
- Marco Ceresoli
- Department of General Surgery, School of Medicine, University of Milano
- Ferdinando Agresta
- Department of General Surgery ULSS5 del Veneto
- Niccolò Allievi
- General Surgery Papa Giovanni XXII Hospital Bergamo
- Giovanni Bellanova
- S.S. Annunziata Hospital
- Federico Coccolini
- Unit of General and Emergency Surgery, Ospedale Bufalini Cesena, AUSL Romagna
- Claudio Coy
- Colorectal Unit, Campinas State University
- Paola Fugazzola
- General Surgery Papa Giovanni XXII Hospital Bergamo
- Carlos Augusto Martinez
- Division of Colorectal Surgery, University of Campinas
- Giulia Montori
- General Surgery ASST
- Ciro Paolillo
- Emergency Department Udine Healthcare and University Integrated Trust
- Thiago Josè Penachim
- Centro Radiológico Campinas, Vera Cruz Hospital
- Bruno Pereira
- Department of Surgery, University of Campinas
- Tarcisio Reis
- Oncology Surgery and Intensive Care, Oswaldo Cruz Hospital
- Angelo Restivo
- Colorectal Unit, Department of Surgery, University of Cagliari
- Joao Rezende-Neto
- Department of Surgery Division of General Surgery, University of Toronto
- Massimo Sartelli
- Surgical Department, University of Macerata
- Massimo Valentino
- Radiology Unit Emergency Department, S. Antonio Abate Hospital
- Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University
- Itamar Ashkenazi
- Hillel Yaffe Medical Center Hadera
- Miklosh Bala
- Trauma and Acute Care Surgery Unit Hadassah, Hebrew University Medical Center
- Osvaldo Chiara
- Trauma TeamGOM Niguarda
- Nicola de’ Angelis
- Unit of Digestive Surgery, HPB Surgery and Liver Transplant Henri Mondor Hospital
- Simona Deidda
- Colorectal Unit, Department of Surgery, University of Cagliari
- Belinda De Simone
- Department of General and Emergency Surgery Cannes’ Hospital Cannes
- Salomone Di Saverio
- Cambridge Colorectal Unit, Cambridge University Hospitals
- Elena Finotti
- Department of General Surgery ULSS5 del Veneto
- Inaba Kenji
- Division of Trauma & Critical Care University of Southern California
- Ernest Moore
- Department of Surgery, Denver Health Medical Center, University of Colorado
- Steven Wexner
- Digestive Disease Center, Department of Colorectal Surgery Cleveland Clinic Florida
- Walter Biffl
- Acute Care Surgery The Queen’s Medical Center
- Raul Coimbra
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego Health Sciences
- Angelo Guttadauro
- Department of General Surgery, School of Medicine, University of Milano
- Ari Leppäniemi
- Second Department of Surgery, Meilahti Hospital
- Ron Maier
- Department of Surgery, Harborview Medical Centre
- Stefano Magnone
- General Surgery Papa Giovanni XXII Hospital Bergamo
- Alain Chicom Mefire
- Department of Surgery and Obs/Gyn, Faculty of Health Sciences, University of Buea
- Andrew Peitzmann
- Department of Surgery, Trauma and Surgical Services, University of Pittsburgh School of Medicine
- Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George
- Michael Sugrue
- General Surgery Department, Letterkenny Hospital
- Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant’Orsola Hospital, University of Bologna
- Dieter Weber
- Trauma and General Surgeon, Royal Perth Hospital
- Jeffry Kashuk
- Surgery and Critical Care Assuta Medical Centers
- Gustavo P. Fraga
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp)
- Ioran Kluger
- Department of General Surgery, Division of Surgery, Rambam Health Care Campus
- Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital
- Luca Ansaloni
- Unit of General and Emergency Surgery, Ospedale Bufalini Cesena, AUSL Romagna
- DOI
- https://doi.org/10.1186/s13017-018-0192-3
- Journal volume & issue
-
Vol. 13,
no. 1
pp. 1 – 27
Abstract
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.
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