Abstract
Although colorectal cancer remains the third most common malignancy worldwide [1], it is highly treatable in its early stages. Unfortunately, 10–29 % of patients with colorectal cancer will present with a large bowel obstruction [2–5]. This poses a challenging clinical dilemma for patients and physicians alike.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–86.
Cheynel N, Cortet M, Lepage C, et al. Trends in frequency and management of obstructing colorectal cancers in a well-defined population. Dis Colon Rectum. 2007;50:1568–75.
Winner M, Mooney SJ, Hershman DL, et al. Incidence and predictors of bowel obstruction in elderly patients with stage IV colon cancer: a population-based cohort study. JAMA Surg. 2013;148:715–22.
Setti Carraro PG, Segala M, Cesana B, et al. Obstructing colonic cancer: failure and survival patterns over a ten-year follow-up after one-stage curative surgery. Dis Colon Rectum. 2001;44:243–50.
Yeo HL, Lee SW. Colorectal emergencies: review and controversies in the management of large bowel obstruction. J Gastrointest Surg. 2013;17:2007–12.
Gustavsson B, Carlsson G, Machover D, et al. A review of the evolution of systemic chemotherapy in the management of colorectal cancer. Clin Colorectal Cancer. 2015;14(1):1–10.
Brozek JL, Akl EA, Alonso-Coello P, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Allergy. 2009;64(5):669–77.
Runkel NS, Hinz U, Lehnert T, et al. Improved outcome after emergency surgery for cancer of the large intestine. Br J Surg. 1998;85:1260–5.
Garci-Valdecasas JC, Llovera JM, deLacy AM, et al. Obstructing colorectal carcinomas. Prospective study. Dis Colon Rectum. 1991;34(9):759–62.
Lee YM, Law WL, Chu KW, et al. Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left sided lesions. J Am Coll Surg. 2001;192:719–25.
Korenaga D, Ueo H, Mochida K, et al. Prognostic factors in Japanese patients with colorectal cancer: the significance of large bowel obstruction – univariate and multivariate analyses. J Surg Oncol. 1991;47:188–92.
Buechter KJ, Boustany C, Caillouette R, et al. Surgical management of the acutely obstructed colon. A review of 127 cases. Am J Surg. 1988;156:163e8.
Tekkis PP, Kinsman R, Thompson MR, et al. The association of coloproctology of great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg. 2004;240:76–81.
McArdle CS, Hole DJ. Emergency presentation of colorectal cancer is associated with poor 5 year survival. Br J Surg. 2004;91:605–9.
Diggs JC, Xu F, Diaz M, et al. Failure to screen: predictors and burden of emergency colorectal cancer resection. Am J Manag Care. 2007;13:157–64.
Smothers L, Hynan L, Fleming J, et al. Emergency surgery for colon carcinoma. Dis Colon Rectum. 2003;46:24–30.
Biondo S, Martí-Ragué J, Kreisler E, et al. A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg. 2005;189:377–83.
Ascanelli S, Navarra G, Tonini G, et al. Early and late outcome after surgery for colorectal cancer: elective versus emergency surgery. Tumori. 2003;89:36–41.
Anderson JH, Hole D, McArdle CS. Elective versus emergency surgery for patients with colorectal cancer. Br J Surg. 1992;79:706.
Wong SK, Jalaludin BB, Morgan MJ, et al. Tumor pathology and long-term survival in emergency colorectal cancer. Dis Colon Rectum. 2008;51:223–30.
Faron M, Pignon JP, Malka D, et al. Is primary tumour resection associated with survival improvement in patients with colorectal cancer and unresectable synchronous metastases? A pooled analysis of individual data from four randomised trials. Eur J Cancer. 2015;51(2):166–76.
Ruo L, Gougoutas C, Paty PB, et al. Elective bowel resection for incurable stage IV colorectal cancer: prognostic variables for asymptomatic patients. J Am Coll Surg. 2003;196(5):722–8.
Liu SK, Church JM, Lavery IC, Fazio VW. Operation in patients with incurable colon cancer—is it worthwhile? Dis Colon Rectum. 1997;40(1):11–4.
Konyalian VR, Rosing DK, Haukoos JS, et al. The role of primary tumour resection in patients with stage IV colorectal cancer. Colorectal Dis. 2007;9(5):430–7.
Nugent KP, Daniels P, Stewart B, et al. Quality of life in stoma patients. Dis Colon Rectum. 1999;42:1569–74.
Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon. Br J Surg. 1994;81(9):1270e6.
Gianotti L, Tamini N, Nespoli L, et al. A prospective evaluation of short-term and long-term results from colonic stenting for palliation or as a bridge to elective operation versus immediate surgery for large-bowel obstruction. Surg Endosc. 2013;27:832–42.
Amelung FJ, Mulder CLJ, Verheijen PM, et al. Acute resection versus bridge to surgery with diverting colostomy for patient with acute malignant left sided colonic obstruction: systematic review and meta-analysis. Surg Oncol. 2015;23:313–21.
Nagula S, Ishill N, Nash C, et al. Quality of life and symptom control after stent placement or surgical palliation of malignant colorectal obstruction. J Am Coll Surg. 2010;210:45–53.
Park JJ, Del Pino A, Orsay PC, et al. Stoma complications: the Cook County Hospital experience. Dis Colon Rectum. 1999;42:1575–80.
Dohmoto M. New method: endoscopic implantation of rectal stent in palliative treatment of malignant stenosis. Endosc Dig. 1991;3:1507–12.
Cheung HY, Chung CC, Tsang WW, Wong JC, Yau KK, Li MK. Endolaparoscopic approach vs conventional open surgery in the treatment of obstructing left-sided colon cancer: a randomized controlled trial. Arch Surg. 2009;144:1127–32.
Lim SG, Lee KJ, Suh KW, Oh SY, Kim SS, Yoo JH, Wi JO. Preoperative colonoscopy for detection of synchronous neoplasms after insertion of self-expandable metal stents in occlusive colorectal cancer: comparison of covered and uncovered stents. Gut Liver. 2013;7:311–6.
Cha EY, Park SH, Lee SS, et al. CT colonography after metallic stent placement for acute malignant colonic obstruction. Radiology. 2010;254:774–82.
van Halsema EE, van Hooft JE, Small AJ, et al. Perforation in colorectal stenting: a meta-analysis and a search for risk factors. Gastrointest Endosc. 2014;79(6):970–82.
Watt AM, Faragher IG, Griffin TT, et al. Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg. 2007;246:24–30.
Lee JH, Yoon JY, Park SJ, et al. The learning curve for colorectal stent insertion for the treatment of malignant colorectal obstruction. Gut Liver. 2012;6:328–33.
Williams D, Law R, Pullyblank AM. Colorectal stenting in malignant large bowel obstruction: the learning curve. Int J Surg Oncol. 2011;2011:917848. doi:10.1155/2011/917848.
Lee HJ, Park SJ, Cheon JH, Kim TI, Kim WH, Hong SP. What is the necessity of endoscopist for successful endoscopic stenting in patients with malignant colorectal obstruction? Int J Colorectal Dis. 2015;30(1):119–25.
Biagi JJ, Raphael MJ, Mackillop WJ, et al. Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis. JAMA. 2011;305:2335–42.
Tejero E, Mainar A, Fernandez L, et al. New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum. 1994;37:1158–9.
Selinger CP, Ramesh J, Martin DF. Long-term success of colonic stent insertion is influenced by indication but not by length of stent or site of obstruction. Int J Colorectal Dis. 2011;26:215–8.
Dronamraju SS, Ramamurthy S, Kelly SB, et al. Role of self-expanding metallic stents in the management of malignant obstruction of the proximal colon. Dis Colon Rectum. 2009;52:1657–61.
Cho YK, Kim SW, Lee BI, et al. Clinical outcome of self-expandable metal stent placement in the management of malignant proximal colon obstruction. Gut Liver. 2011;5:165–710.
Geraghty J, Sarkar S, Cox T, et al. Management of large bowel obstruction with self-expanding metal stents: a multicentre retrospective study of factors determining outcome. Colorectal Dis. 2014;16:476–83.
Lee HJ, Hong SP, Cheon JH, et al. Long-term outcome of palliative therapy for malignant colorectal obstruction in patients with unresectable metastatic colorectal cancers: endoscopic stenting versus surgery. Gastrointest Endosc. 2011;73(3):535–42.
Young CJ, De-loyde KJ, Young JM, et al. Improving quality of life for people with incurable large-bowel obstruction: randomized control trial of colonic stent insertion. Dis Colon Rectum. 2015;58(9):838–49.
Zhang Y, Shi J, Shi B, et al. Self-expanding metallic stent as a bridge to surgery versus emergency surgery for obstructive colorectal cancer: a meta-analysis. Surg Endosc. 2012;26:110–9.
Zhao XD, Cai BB, Cao RS, et al. Palliative treatment for incurable malignant colorectal obstructions: a meta-analysis. World J Gastroenterol. 2013;19:5565–74.
Liang TW, Sun Y, Wei YC, et al. Palliative treatment of malignant colorectal obstruction caused by advanced malignancy: a self-expanding metallic stent or surgery? A system review and meta-analysis. Surg Today. 2014;44:22–33.
Takahashi H, Okabayashi K, Tsuruta M, et al. Self-expanding metallic stents versus surgical intervention as palliative therapy for obstructive colorectal cancer: a meta-analysis. World J Surg. 2015;18:1–8.
Martinez-Santos C, Lobato RF, Fradejas JM, et al. Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum. 2002;45:401–6.
Jiménez-Pérez J, Casellas J, García-Cano J, et al. Colonic stenting as a bridge to surgery in malignant large-bowel obstruction: a report from two large multinational registries. Am J Gastroenterol. 2011;106:2174–80.
Meisner S, Gonzalez-Huix F, Vandervoort JG, et al. Self-expandable metal stents for relieving malignant colorectal obstruction: short term safety and efficacy within 30 days of stent procedure in 447 patients. Gastrointest Endosc. 2011;74:876–84.
Pirlet IA, Slim K, Kwiatkowski F, et al. Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial. Surg Endosc. 2011;25:1814–21.
van Hooft JE, Bemelman WA, Oldenburg B, et al. Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol. 2011;12:344–52.
Kavanagh DO, Nolan B, Judge C, et al. A comparative study of short-and medium-term outcomes comparing emergent surgery and stenting as a bridge to surgery in patients with acute malignant colonic obstruction. Dis Colon Rectum. 2013;56(4):433–40.
Ghazal AH, El-Shazly WG, et al. Colonic endolumenal stenting devices and elective surgery versus emergency subtotal/total colectomy in the management of malignant obstructed left colon carcinoma. J Gastrointest Surg. 2013;17:1123–9.
Saito S, Yoshida S, Isayama H, et al. A prospective multicenter study on self-expandable metallic stents as a bridge to surgery for malignant colorectal obstruction in Japan: efficacy and safety in 312 patients. Surgical endoscopy. 2015;18:1–11.
Sagar J. Colorectal stents for the management of malignant colonic obstructions. Cochrane Database Sys Rev. 2011;(11):CD007378.
Tan CJ, Dasari BV, Gardiner K. Systematic review and meta-analysis of randomized clinical trials of self-expanding metallic stents as a bridge to surgery versus emergency surgery for malignant left-sided large bowel obstruction. Br J Surg. 2012;99:469–76.
Cirocchi R, Farinella E, Trastulli S, et al. Safety and efficacy of endoscopic colonic stenting as a bridge to surgery in the management of intestinal obstruction due to left colon and rectal cancer: a systematic review and meta-analysis. Surg Oncol. 2013;22:14–21.
Huang X, Lv B, Zhang S, et al. Preoperative colonic stents versus emergency surgery for acute left-sided malignant colonic obstruction: a meta-analysis. J Gastrointest Surg. 2014;18:584–91.
Matsuda A, Miyashita M, Matsumoto S, et al. Comparison of long-term outcomes of colonic stent as “bridge to surgery” and emergency surgery for malignant large-bowel obstruction: a meta-analysis. Ann Surg Oncol. 2015;22(2):497–504.
Erichsen R, Horvath-Puho E, Jacobsen JB, et al. Long-term mortality and recurrence after colorectal cancer surgery with preoperative stenting: a Danish nationwide cohort study. Endoscopy. 2015;47(6):517–24.
Kim SJ, Kim HW, Park SB, Kang DH, Choi CW, Song BJ, Hong JB, Kim DJ, Park BS, Son GM. Colonic perforation either during or after stent insertion as a bridge to surgery for malignant colorectal obstruction increases the risk of peritoneal seeding. Surg Endosc. 2015;13:1–8.
Sloothaak DA, van den Berg MW, Dijkgraaf MG, et al. Oncological outcome of malignant colonic obstruction in the Dutch Stent-In 2 trial. Br J Surg. 2014;101:1751–7.
Sabbagh C, Browet F, Diouf M, et al. Is stenting as “a bridge to surgery” an oncologically safe strategy for the management of acute, left-sided, malignant, colonic obstruction? A comparative study with a propensity score analysis. Ann Surg. 2013;258:107–15.
Artinyan A, Orcutt ST, Anaya DA, et al. Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg. 2015;261:497–505.
Guo MG, Feng Y, Zheng Q, et al. Comparison of self-expanding metal stents and urgent surgery for left-sided malignant colonic obstruction in elderly patients. Dig Dis Sci. 2011;56:2706–10.
Symeonidis D, Christodoulidis G, Koukoulis G, et al. Colorectal cancer surgery in the elderly: limitations and drawbacks. Tech Coloproctol. 2011;15 suppl 1:S47–50.
Monson JRT, Weiser RM, Buie WD, et al. Practice parameters for the management of recal cancer. Dis Colon Rectum. 2014;56:535–50.
Gorissen KJ, Tuynman JB, Fryer E, et al. Local recurrence after stenting for obstructing left-sided colonic cancer. Br J Surg. 2013;100:1805–09.
Alcantara M, Serra-Aracil X, Falco J, et al. Prospective, controlled, randomized study of intra- operative colonic lavage versus stent placement in obstructive left-sided colonic cancer. World J Surg. 2011;35:1904–10.
Ho KS, Quah HM, Lim JF, et al. Endoscopic stenting and elective surgery versus emergency surgery for left-sided malignant colonic obstruction: a prospective randomized trial. Int J Colorectal Dis 2012;27(3):355–62.
Cennamo V, Luigiano C, Coccolini F, et al. Meta-analysis of randomized trials comparing endoscopic stenting and surgical decompression for colorectal cancer obstruction. Int J Colorectal Dis. 2013;28(6):855–63.
Tung KL, Cheung HY, Ng LW, et al. Endo-laparoscopic approach versus conventional open surgery in the treatment of obstructing left-sided colon cancer: long-term follow-up of a randomized trial. Asian J Endosc Surg. 2013;6:78–81.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Singer, M.A., Orkin, B.A. (2017). Management of Patients with Acute Large Bowel Obstruction from Colon Cancer. In: Hyman, N., Umanskiy, K. (eds) Difficult Decisions in Colorectal Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-40223-9_13
Download citation
DOI: https://doi.org/10.1007/978-3-319-40223-9_13
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-40222-2
Online ISBN: 978-3-319-40223-9
eBook Packages: MedicineMedicine (R0)