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 & 31 others 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

Research output: Contribution to journalReview article

11 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article number36
JournalWorld Journal of Emergency Surgery
Volume13
Issue number1
DOIs
Publication statusPublished - 13 Aug 2018
Externally publishedYes

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Rectal Neoplasms
Colonic Neoplasms
Colon
Emergencies
Guidelines
Carcinoma
Colorectal Neoplasms
Ileostomy
Colostomy
Colectomy
Patient Rights
Peritonitis
Resuscitation
Publications
Therapeutics
Anti-Bacterial Agents
Self Expandable Metallic Stents

Cite this

Pisano, M., Zorcolo, L., Merli, C., Cimbanassi, S., Poiasina, E., Ceresoli, M., ... Ansaloni, L. (2018). 2017 WSES guidelines on colon and rectal cancer emergencies: Obstruction and perforation. World Journal of Emergency Surgery, 13(1), [36]. https://doi.org/10.1186/s13017-018-0192-3
Pisano, Michele ; Zorcolo, Luigi ; Merli, Cecilia ; Cimbanassi, Stefania ; Poiasina, Elia ; Ceresoli, Marco ; Agresta, Ferdinando ; Allievi, Niccolò ; Bellanova, Giovanni ; Coccolini, Federico ; Coy, Claudio ; Fugazzola, Paola ; Martinez, Carlos Augusto ; Montori, Giulia ; Paolillo, Ciro ; Penachim, Thiago Josè ; Pereira, Bruno ; Reis, Tarcisio ; Restivo, Angelo ; Rezende-Neto, Joao ; Sartelli, Massimo ; Valentino, Massimo ; Abu-Zidan, Fikri M. ; Ashkenazi, Itamar ; Bala, Miklosh ; Chiara, Osvaldo ; de' Angelis, Nicola ; Deidda, Simona ; De Simone, Belinda ; Di Saverio, Salomone ; Finotti, Elena ; Kenji, Inaba ; Moore, Ernest ; Wexner, Steven ; Biffl, Walter ; Coimbra, Raul ; Guttadauro, Angelo ; Leppäniemi, Ari ; Maier, Ron ; Magnone, Stefano ; Mefire, Alain Chicom ; Peitzmann, Andrew ; Sakakushev, Boris ; Sugrue, Michael ; Viale, Pierluigi ; Weber, Dieter ; Kashuk, Jeffry ; Fraga, Gustavo P. ; Kluger, Ioran ; Catena, Fausto ; Ansaloni, Luca. / 2017 WSES guidelines on colon and rectal cancer emergencies : Obstruction and perforation. In: World Journal of Emergency Surgery. 2018 ; Vol. 13, No. 1.
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abstract = "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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author = "Michele Pisano and Luigi Zorcolo and Cecilia Merli and Stefania Cimbanassi and Elia Poiasina and Marco Ceresoli and Ferdinando Agresta and Niccol{\`o} Allievi and Giovanni Bellanova and Federico Coccolini and Claudio Coy and Paola Fugazzola and Martinez, {Carlos Augusto} and Giulia Montori and Ciro Paolillo and Penachim, {Thiago Jos{\`e}} and Bruno Pereira and Tarcisio Reis and Angelo Restivo and Joao Rezende-Neto and Massimo Sartelli and Massimo Valentino and Abu-Zidan, {Fikri M.} and Itamar Ashkenazi and Miklosh Bala and Osvaldo Chiara and {de' Angelis}, Nicola and Simona Deidda and {De Simone}, Belinda and {Di Saverio}, Salomone and Elena Finotti and Inaba Kenji and Ernest Moore and Steven Wexner and Walter Biffl and Raul Coimbra and Angelo Guttadauro and Ari Lepp{\"a}niemi and Ron Maier and Stefano Magnone and Mefire, {Alain Chicom} and Andrew Peitzmann and Boris Sakakushev and Michael Sugrue and Pierluigi Viale and Dieter Weber and Jeffry Kashuk and Fraga, {Gustavo P.} and Ioran Kluger and Fausto Catena and Luca Ansaloni",
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Pisano, M, Zorcolo, L, Merli, C, Cimbanassi, S, Poiasina, E, Ceresoli, M, Agresta, F, Allievi, N, Bellanova, G, Coccolini, F, Coy, C, Fugazzola, P, Martinez, CA, Montori, G, Paolillo, C, Penachim, TJ, Pereira, B, Reis, T, Restivo, A, Rezende-Neto, J, Sartelli, M, Valentino, M, Abu-Zidan, FM, Ashkenazi, I, Bala, M, Chiara, O, de' Angelis, N, Deidda, S, De Simone, B, Di Saverio, S, Finotti, E, Kenji, I, Moore, E, Wexner, S, Biffl, W, Coimbra, R, Guttadauro, A, Leppäniemi, A, Maier, R, Magnone, S, Mefire, AC, Peitzmann, A, Sakakushev, B, Sugrue, M, Viale, P, Weber, D, Kashuk, J, Fraga, GP, Kluger, I, Catena, F & Ansaloni, L 2018, '2017 WSES guidelines on colon and rectal cancer emergencies: Obstruction and perforation' World Journal of Emergency Surgery, vol. 13, no. 1, 36. https://doi.org/10.1186/s13017-018-0192-3

2017 WSES guidelines on colon and rectal cancer emergencies : Obstruction and perforation. / Pisano, Michele; Zorcolo, Luigi; Merli, Cecilia; Cimbanassi, Stefania; Poiasina, Elia; Ceresoli, Marco; Agresta, Ferdinando; Allievi, Niccolò; Bellanova, Giovanni; Coccolini, Federico; Coy, Claudio; Fugazzola, Paola; Martinez, Carlos Augusto; Montori, Giulia; Paolillo, Ciro; Penachim, Thiago Josè; Pereira, Bruno; Reis, Tarcisio; Restivo, Angelo; Rezende-Neto, Joao; Sartelli, Massimo; Valentino, Massimo; Abu-Zidan, Fikri M.; Ashkenazi, Itamar; Bala, Miklosh; Chiara, Osvaldo; de' Angelis, Nicola; Deidda, Simona; De Simone, Belinda; Di Saverio, Salomone; Finotti, Elena; Kenji, Inaba; Moore, Ernest; Wexner, Steven; Biffl, Walter; Coimbra, Raul; Guttadauro, Angelo; Leppäniemi, Ari; Maier, Ron; Magnone, Stefano; Mefire, Alain Chicom; Peitzmann, Andrew; Sakakushev, Boris; Sugrue, Michael; Viale, Pierluigi; Weber, Dieter; Kashuk, Jeffry; Fraga, Gustavo P.; Kluger, Ioran; Catena, Fausto; Ansaloni, Luca.

In: World Journal of Emergency Surgery, Vol. 13, No. 1, 36, 13.08.2018.

Research output: Contribution to journalReview article

TY - JOUR

T1 - 2017 WSES guidelines on colon and rectal cancer emergencies

T2 - Obstruction and perforation

AU - Pisano, Michele

AU - Zorcolo, Luigi

AU - Merli, Cecilia

AU - Cimbanassi, Stefania

AU - Poiasina, Elia

AU - Ceresoli, Marco

AU - Agresta, Ferdinando

AU - Allievi, Niccolò

AU - Bellanova, Giovanni

AU - Coccolini, Federico

AU - Coy, Claudio

AU - Fugazzola, Paola

AU - Martinez, Carlos Augusto

AU - Montori, Giulia

AU - Paolillo, Ciro

AU - Penachim, Thiago Josè

AU - Pereira, Bruno

AU - Reis, Tarcisio

AU - Restivo, Angelo

AU - Rezende-Neto, Joao

AU - Sartelli, Massimo

AU - Valentino, Massimo

AU - Abu-Zidan, Fikri M.

AU - Ashkenazi, Itamar

AU - Bala, Miklosh

AU - Chiara, Osvaldo

AU - de' Angelis, Nicola

AU - Deidda, Simona

AU - De Simone, Belinda

AU - Di Saverio, Salomone

AU - Finotti, Elena

AU - Kenji, Inaba

AU - Moore, Ernest

AU - Wexner, Steven

AU - Biffl, Walter

AU - Coimbra, Raul

AU - Guttadauro, Angelo

AU - Leppäniemi, Ari

AU - Maier, Ron

AU - Magnone, Stefano

AU - Mefire, Alain Chicom

AU - Peitzmann, Andrew

AU - Sakakushev, Boris

AU - Sugrue, Michael

AU - Viale, Pierluigi

AU - Weber, Dieter

AU - Kashuk, Jeffry

AU - Fraga, Gustavo P.

AU - Kluger, Ioran

AU - Catena, Fausto

AU - Ansaloni, Luca

PY - 2018/8/13

Y1 - 2018/8/13

N2 - 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.

AB - 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.

KW - Cancer

KW - Colon

KW - Emergency

KW - Obstruction

KW - Perforation

KW - Rectum

UR - http://www.scopus.com/inward/record.url?scp=85051728351&partnerID=8YFLogxK

U2 - 10.1186/s13017-018-0192-3

DO - 10.1186/s13017-018-0192-3

M3 - Review article

VL - 13

JO - World Journal of Emergency Surgery

JF - World Journal of Emergency Surgery

SN - 1749-7922

IS - 1

M1 - 36

ER -