Surgical management of obstructed and perforated colorectal cancer: still debating and unresolved issues

Abstract

SUMMARY Emergency surgery for obstruction and perforation from colorectal cancer (CRC) predicts poorer outcomes compared with elective surgery. For obstructed cancers, the evidence suggests significantly poorer outcomes with multistaged procedures compared with single-stage procedures in this group. Stenting remains an attractive option as a ‘bridge-to-surgery’, with multiple single-center studies demonstrating excellent short-term outcomes. However, contradictory evidence from three randomized trials casts doubts on stenting as the preferred modality for initial management of all curative obstructed CRCs. Results from a UK multicenter randomized controlled trial are still awaited. Palliative stenting shows predominantly positive results and is a valuable option for nonresectable or incurable CRCs. All authors agree on emergency surgery as the primary modality of treatment for perforated malignancies. Short-term outcomes are markedly poorer than the elective surgery group and correlate with the degree of peritoneal contamination. Long-term outcomes are comparable to elective surgery when perioperative deaths are excluded.