Surgical Management of Complicated Colon Cancer

Abstract

The management of complicated colon cancer (locally invasive, obstructed, or perforated cancers) can pose diagnostic and therapeutic challenges to surgical management. Adherence to traditional surgical oncologic principles must often be balanced with the patients' clinical presentation and other parameters. While the goal of an R0 (no residual microscopic disease) resection must always be kept in mind, situations sometimes arise which can make this difficult to achieve. Recognition of complicated disease and availability of varied therapeutic modalities is important to ensure favorable patient outcomes. This review will discuss the surgical management of complicated colon cancer, with special focus on locally advanced disease.

Keywords

colonic stent - large bowel obstruction - colon cancer - multivisceral resection - colon perforation

• References

• 1 Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin 2014; 64 (1) 9-29
• 2 Sugarbaker ED. Coincident removal of additional structures in resections for carcinoma of the colon and rectum. Ann Surg 1946; 123: 1036-1046
• 3 Lehnert T, Methner M, Pollok A, Schaible A, Hinz U, Herfarth C. Multivisceral resection for locally advanced primary colon and rectal cancer: an analysis of prognostic factors in 201 patients. Ann Surg 2002; 235 (2) 217-225
• 4 Croner RS, Merkel S, Papadopoulos T, Schellerer V, Hohenberger W, Goehl J. Multivisceral resection for colon carcinoma. Dis Colon Rectum 2009; 52 (8) 1381-1386
• 5 Vignali A, Ghirardelli L, Di Palo S, Orsenigo E, Staudacher C. Laparoscopic treatment of advanced colonic cancer: a case-matched control with open surgery. Colorectal Dis 2013; 15 (8) 944-948
• 6 Hallet J, Zih FS, Lemke M, Milot L, Smith AJ, Wong CS. Neo-adjuvant chemoradiotherapy and multivisceral resection to optimize R0 resection of locally recurrent adherent colon cancer. Eur J Surg Oncol 2014; 40 (6) 706-712
• 7 Cukier M, Smith AJ, Milot L , et al. Neoadjuvant chemoradiotherapy and multivisceral resection for primary locally advanced adherent colon cancer: a single institution experience. Eur J Surg Oncol 2012; 38 (8) 677-682
• 8 Waldron RP, Donovan IA, Drumm J, Mottram SN, Tedman S. Emergency presentation and mortality from colorectal cancer in the elderly. Br J Surg 1986; 73 (3) 214-216
• 9 Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon. Br J Surg 1994; 81 (9) 1270-1276
• 10 Tan CC, Iftikhar SY, Allan A, Freeman JG. Local effects of colorectal cancer are well palliated by endoscopic laser therapy. Eur J Surg Oncol 1995; 21 (6) 648-652
• 11 Grund KE, Storek D, Farin G. Endoscopic argon plasma coagulation (APC) first clinical experiences in flexible endoscopy. Endosc Surg Allied Technol 1994; 2 (1) 42-46
• 12 Eckhauser ML, Mansour EG. Endoscopic laser therapy for obstructing and/or bleeding colorectal carcinoma. Am Surg 1992; 58 (6) 358-363
• 13 Gainant A. Emergency management of acute colonic cancer obstruction. J Vis Surg 2012; 149 (1) e3-e10
• 14 Güenaga KF, Matos D, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 2011; (9) CD001544
• 15 Ruggiero R, Sparavigna L, Docimo G , et al. Post-operative peritonitis due to anastomotic dehiscence after colonic resection. Multicentric experience, retrospective analysis of risk factors and review of the literature. Ann Ital Chir 2011; 82 (5) 369-375
• 16 Dohmoto M, Hünerbein M, Schlag PM. Application of rectal stents for palliation of obstructing rectosigmoid cancer. Surg Endosc 1997; 11 (7) 758-761
• 17 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 (12) 1127-1132
• 18 van Hooft JE, Bemelman WA, Oldenburg B , et al; collaborative Dutch Stent-In study group. Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol 2011; 12 (4) 344-352
• 19 Pirlet IA, Slim K, Kwiatkowski F, Michot F, Millat BL. Emergency preoperative stenting versus surgery for acute left-sided malignant colonic obstruction: a multicenter randomized controlled trial. Surg Endosc 2011; 25 (6) 1814-1821
• 20 Ho KS, Quah HM, Lim JF, Tang CL, Eu KW. 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) 355-362
• 21 Alcántara M, Serra-Aracil X, Falcó J, Mora L, Bombardó J, Navarro S. Prospective, controlled, randomized study of intraoperative colonic lavage versus stent placement in obstructive left-sided colonic cancer. World J Surg 2011; 35 (8) 1904-1910
• 22 Ghazal AH, El-Shazly WG, Bessa SS, El-Riwini MT, Hussein AM. 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 (6) 1123-1129
• 23 Van den Berg MW, Ledeboer M, Dijkgraff MG, Fockens P, ter Borg F, van Hooft JE. Long-term results of palliative stent placement for acute malignant colonic obstruction. Surg Endosc 2015; 29 (6) 1580-1585
• 24 Quereshy FA, Poon JT, Law WL. Long-term outcome of stenting as a bridge to surgery for acute left-sided malignant colonic obstruction. Colorectal Dis 2014; 16 (10) 788-793
• 25 Poultsides GA, Servais EL, Saltz LB , et al. Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. J Clin Oncol 2009; 27 (20) 3379-3384
• 26 Anwar MA, D'Souza F, Coulter R, Memon B, Khan IM, Memon MA. Outcome of acutely perforated colorectal cancers: experience of a single district general hospital. Surg Oncol 2006; 15 (2) 91-96
• 27 Biondo S, Kreisler E, Millan M , et al. Differences in patient postoperative and long-term outcomes between obstructive and perforated colonic cancer. Am J Surg 2008; 195 (4) 427-432
• 28 Zielinski MD, Merchea A, Heller SF, You YN. Emergency management of perforated colon cancers: how aggressive should we be?. J Gastrointest Surg 2011; 15 (12) 2232-2238