Treatment strategy for the obstructive or perforated rectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Yang ,  YAO Hongwei

Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; National Clinical Research Center for Digestive Diseases, State Key Lab of Digestive Health, Beijing 100050, P. R. China;

Corresponding author：

YAO Hongwei, Email: yaohongwei@ccmu.edu.cn

Keywords：

rectal cancer; obstructive rectal cancer; perforated rectal cancer; emergency surgery; self-expanding metallic stents

DOI：

10.7507/1007-9424.202311013

Video：

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Abstract Full text Figures/Tables Video References Cited by

Colorectal cancer is one of the common malignant tumor in the world, and about 57.6% of colorectal cancer surgical cases in our country are rectal cancer patients, which occupies a major proportion. Some patients with rectal cancer may already have emergencies such as intestinal obstruction or limited perforation at the time of consultation, which require immediate relevant treatment measures. Currently, there are multiple surgical and endoscopic treatment strategies available for obstructive and perforated rectal cancer. Surgeons need to perform an accurate and comprehensive assessment of the disease, define the goals of the current treatment, and formulate an appropriate treatment plan based on the patient’s clinical and oncological status in order to optimize the patient’s oncological outcome while minimizing the risk of complications associated with emergency colorectal surgery.

Citation： LI Yang, YAO Hongwei. Treatment strategy for the obstructive or perforated rectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(12): 1409-1414. doi: 10.7507/1007-9424.202311013 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	姚宏伟, 李心翔, 崔龙, 等. 中国结直肠癌手术病例登记数据库2022年度报告: 一项全国性登记研究. 中国实用外科杂志, 2023, 43(1): 93-99.
3.	Barnett A, Cedar A, Siddiqui F, et al. Colorectal cancer emergencies. J Gastrointest Cancer, 2013, 44(2): 132-142.
4.	Gunnarsson H, Holm T, Ekholm A, et al. Emergency presentation of colon cancer is most frequent during summer. Colorectal Dis, 2011, 13(6): 663-668.
5.	Baer C, Menon R, Bastawrous S, et al. Emergency presentations of colorectal cancer. Surg Clin North Am, 2017, 97(3): 529-545.
6.	Schwenter F, Morel P, Gervaz P. Management of obstructive and perforated colorectal cancer. Expert Rev Anticancer Ther, 2010, 10(10): 1613-1619.
7.	Ho YH, Siu SK, Buttner P, et al. The effect of obstruction and perforation on colorectal cancer disease-free survival. World J Surg, 2010, 34(5): 1091-1101.
8.	Abe I, Kawamura YJ, Konishi F. Laparoscopic colectomy for obstructive colorectal carcinoma. Surg Laparosc Endosc Percutan Tech, 2013, 23(6): 518-523.
9.	高峰, 徐明. 梗阻性直肠癌的处理策略. 中华结直肠疾病电子杂志, 2015, 4(6): 596-599.
10.	Coratti F, Maggioni C, Mongelli C, et al. Laparoscopic reversal of the Hartmann procedure —a video vignette. Colorectal Dis, 2020, 22(2): 224.
11.	楼征, 张卫. 梗阻性结直肠癌造口方式选择. 中国实用外科杂志, 2019, 39(12): 1354-1356.
12.	Otsuka S, Kaneoka Y, Maeda A, et al. One-stage colectomy with intraoperative colonic irrigation for acute left-sided malignant colonic obstruction. World J Surg, 2015, 39(9): 2336-2342.
13.	Sasaki K, Kazama S, Sunami E, et al. One-stage segmental colectomy and primary anastomosis after intraoperative colonic irrigation and total colonoscopy for patients with obstruction due to left-sided colorectal cancer. Dis Colon Rectum, 2012, 55(1): 72-78.
14.	Dudley HA, Racliffe AG, McGeehan D. Intraoperative irrigation of the colon to permit primary anastomosis. Br J Surg, 1980, 67(2): 80-81.
15.	Tham HY, Lim WH, Jain SR, et al. Is colonic lavage a suitable alternative for left-sided colonic emergencies? World J Gastrointest Surg, 2021, 13(4): 379-391.
16.	Pisano M, Zorcolo L, Merli C, et al. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg, 2018, 13: 36.
17.	Ichise Y, Horiuchi A, Nakayama Y, et al. Techniques and outcomes of endoscopic decompression using transanal drainage tube placement for acute left-sided colorectal obstruction. Gastroenterology Res, 2010, 3(5): 201-206.
18.	Okuda Y, Yamada T, Hirata Y, et al. Long-term outcomes of one stage surgery using transanal colorectal tube for acute colorectal obstruction of stageⅡ/Ⅲ distal colon cancer. Cancer Res Treat, 2019, 51(2): 474-482.
19.	Okuda Y, Shimura T, Kato H, et al. Pathological impact of transanal colorectal tube for obstructive colorectal cancer. Surg Endosc, 2020, 34(9): 4011-4018.
20.	Shimura T, Joh T. Evidence-based clinical management of acute malignant colorectal obstruction. J Clin Gastroenterol, 2016, 50(4): 273-285.
21.	Tejero E, Mainar A, Fernández L, et al. New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum, 1994, 37(11): 1158-1159.
22.	Tomita M, Saito S, Makimoto S, et al. Self-expandable metallic stenting as a bridge to surgery for malignant colorectal obstruction: pooled analysis of 426 patients from two prospective multicenter series. Surg Endosc, 2019, 33(2): 499-509.
23.	Lee YJ, Yoon JY, Park JJ, et al. Clinical outcomes and factors related to colonic perforations in patients receiving self-expandable metal stent insertion for malignant colorectal obstruction. Gastrointest Endosc, 2018, 87(6): 1548-1557.
24.	Spannenburg L, Sanchez Gonzalez M, Brooks A, et al. Surgical outcomes of colonic stents as a bridge to surgery versus emergency surgery for malignant colorectal obstruction: A systematic review and meta-analysis of high quality prospective and randomised controlled trials. Eur J Surg Oncol, 2020, 46(8): 1404-1414.
25.	Amelung FJ, Borstlap WAA, Consten ECJ, et al. Propensity score-matched analysis of oncological outcome between stent as bridge to surgery and emergency resection in patients with malignant left-sided colonic obstruction. Br J Surg, 2019, 106(8): 1075-1086.
26.	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, 39(8): 2037-2044.
27.	Gorissen KJ, Tuynman JB, Fryer E, et al. Local recurrence after stenting for obstructing left-sided colonic cancer. Br J Surg, 2013, 100(13): 1805-1809.
28.	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(1): 107-115.
29.	Yamashita S, Tanemura M, Sawada G, et al. Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer. Oncol Lett, 2018, 15(1): 400-406.
30.	Takahashi G, Yamada T, Iwai T, et al. Oncological assessment of stent placement for obstructive colorectal cancer from circulating cell-free DNA and circulating tumor DNA dynamics. Ann Surg Oncol, 2018, 25(3): 737-744.
31.	Malgras B, Brullé L, Lo Dico R, et al. Insertion of a stent in obstructive colon cancer can induce a metastatic process in an experimental murine model. Ann Surg Oncol, 2015, 22 Suppl 3: S1475-S1480. doi: 10.1245/s10434-015-4588-y.
32.	van Hooft JE, van Halsema EE, Vanbiervliet G, et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Gastrointest Endosc, 2014, 80(5): 747-761.
33.	Lee GJ, Kim HJ, Baek JH, et al. Comparison of short-term outcomes after elective surgery following endoscopic stent insertion and emergency surgery for obstructive colorectal cancer. Int J Surg, 2013, 11(6): 442-446.
34.	Ormando VM, Palma R, Fugazza A, et al. Colonic stents for malignant bowel obstruction: current status and future prospects. Expert Rev Med Devices, 2019, 16(12): 1053-1061.
35.	Han JG, Wang ZJ, Dai Y, et al. Short-term outcomes of elective surgery following self-expandable metallic stent and neoadjuvant chemotherapy in patients with left-sided colon cancer obstruction. Dis Colon Rectum, 2023, 66(10): 1319-1328.
36.	Langell JT, Mulvihill SJ. Gastrointestinal perforation and the acute abdomen. Med Clin North Am, 2008, 92(3): 599-625.
37.	Tzivanakis A, Moran BJ. Perforated colorectal cancer. Clin Colon Rectal Surg, 2020, 33(5): 247-252.
38.	Kriwanek S, Armbruster C, Dittrich K, et al. Perforated colorectal cancer. Dis Colon Rectum, 1996, 39(12): 1409-1414.

1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. 姚宏伟, 李心翔, 崔龙, 等. 中国结直肠癌手术病例登记数据库2022年度报告: 一项全国性登记研究. 中国实用外科杂志, 2023, 43(1): 93-99.
3. Barnett A, Cedar A, Siddiqui F, et al. Colorectal cancer emergencies. J Gastrointest Cancer, 2013, 44(2): 132-142.
4. Gunnarsson H, Holm T, Ekholm A, et al. Emergency presentation of colon cancer is most frequent during summer. Colorectal Dis, 2011, 13(6): 663-668.
5. Baer C, Menon R, Bastawrous S, et al. Emergency presentations of colorectal cancer. Surg Clin North Am, 2017, 97(3): 529-545.
6. Schwenter F, Morel P, Gervaz P. Management of obstructive and perforated colorectal cancer. Expert Rev Anticancer Ther, 2010, 10(10): 1613-1619.
7. Ho YH, Siu SK, Buttner P, et al. The effect of obstruction and perforation on colorectal cancer disease-free survival. World J Surg, 2010, 34(5): 1091-1101.
8. Abe I, Kawamura YJ, Konishi F. Laparoscopic colectomy for obstructive colorectal carcinoma. Surg Laparosc Endosc Percutan Tech, 2013, 23(6): 518-523.
9. 高峰, 徐明. 梗阻性直肠癌的处理策略. 中华结直肠疾病电子杂志, 2015, 4(6): 596-599.
10. Coratti F, Maggioni C, Mongelli C, et al. Laparoscopic reversal of the Hartmann procedure —a video vignette. Colorectal Dis, 2020, 22(2): 224.
11. 楼征, 张卫. 梗阻性结直肠癌造口方式选择. 中国实用外科杂志, 2019, 39(12): 1354-1356.
12. Otsuka S, Kaneoka Y, Maeda A, et al. One-stage colectomy with intraoperative colonic irrigation for acute left-sided malignant colonic obstruction. World J Surg, 2015, 39(9): 2336-2342.
13. Sasaki K, Kazama S, Sunami E, et al. One-stage segmental colectomy and primary anastomosis after intraoperative colonic irrigation and total colonoscopy for patients with obstruction due to left-sided colorectal cancer. Dis Colon Rectum, 2012, 55(1): 72-78.
14. Dudley HA, Racliffe AG, McGeehan D. Intraoperative irrigation of the colon to permit primary anastomosis. Br J Surg, 1980, 67(2): 80-81.
15. Tham HY, Lim WH, Jain SR, et al. Is colonic lavage a suitable alternative for left-sided colonic emergencies? World J Gastrointest Surg, 2021, 13(4): 379-391.
16. Pisano M, Zorcolo L, Merli C, et al. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg, 2018, 13: 36.
17. Ichise Y, Horiuchi A, Nakayama Y, et al. Techniques and outcomes of endoscopic decompression using transanal drainage tube placement for acute left-sided colorectal obstruction. Gastroenterology Res, 2010, 3(5): 201-206.
18. Okuda Y, Yamada T, Hirata Y, et al. Long-term outcomes of one stage surgery using transanal colorectal tube for acute colorectal obstruction of stageⅡ/Ⅲ distal colon cancer. Cancer Res Treat, 2019, 51(2): 474-482.
19. Okuda Y, Shimura T, Kato H, et al. Pathological impact of transanal colorectal tube for obstructive colorectal cancer. Surg Endosc, 2020, 34(9): 4011-4018.
20. Shimura T, Joh T. Evidence-based clinical management of acute malignant colorectal obstruction. J Clin Gastroenterol, 2016, 50(4): 273-285.
21. Tejero E, Mainar A, Fernández L, et al. New procedure for the treatment of colorectal neoplastic obstructions. Dis Colon Rectum, 1994, 37(11): 1158-1159.
22. Tomita M, Saito S, Makimoto S, et al. Self-expandable metallic stenting as a bridge to surgery for malignant colorectal obstruction: pooled analysis of 426 patients from two prospective multicenter series. Surg Endosc, 2019, 33(2): 499-509.
23. Lee YJ, Yoon JY, Park JJ, et al. Clinical outcomes and factors related to colonic perforations in patients receiving self-expandable metal stent insertion for malignant colorectal obstruction. Gastrointest Endosc, 2018, 87(6): 1548-1557.
24. Spannenburg L, Sanchez Gonzalez M, Brooks A, et al. Surgical outcomes of colonic stents as a bridge to surgery versus emergency surgery for malignant colorectal obstruction: A systematic review and meta-analysis of high quality prospective and randomised controlled trials. Eur J Surg Oncol, 2020, 46(8): 1404-1414.
25. Amelung FJ, Borstlap WAA, Consten ECJ, et al. Propensity score-matched analysis of oncological outcome between stent as bridge to surgery and emergency resection in patients with malignant left-sided colonic obstruction. Br J Surg, 2019, 106(8): 1075-1086.
26. 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, 39(8): 2037-2044.
27. Gorissen KJ, Tuynman JB, Fryer E, et al. Local recurrence after stenting for obstructing left-sided colonic cancer. Br J Surg, 2013, 100(13): 1805-1809.
28. 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(1): 107-115.
29. Yamashita S, Tanemura M, Sawada G, et al. Impact of endoscopic stent insertion on detection of viable circulating tumor cells from obstructive colorectal cancer. Oncol Lett, 2018, 15(1): 400-406.
30. Takahashi G, Yamada T, Iwai T, et al. Oncological assessment of stent placement for obstructive colorectal cancer from circulating cell-free DNA and circulating tumor DNA dynamics. Ann Surg Oncol, 2018, 25(3): 737-744.
31. Malgras B, Brullé L, Lo Dico R, et al. Insertion of a stent in obstructive colon cancer can induce a metastatic process in an experimental murine model. Ann Surg Oncol, 2015, 22 Suppl 3: S1475-S1480. doi: 10.1245/s10434-015-4588-y.
32. van Hooft JE, van Halsema EE, Vanbiervliet G, et al. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Gastrointest Endosc, 2014, 80(5): 747-761.
33. Lee GJ, Kim HJ, Baek JH, et al. Comparison of short-term outcomes after elective surgery following endoscopic stent insertion and emergency surgery for obstructive colorectal cancer. Int J Surg, 2013, 11(6): 442-446.
34. Ormando VM, Palma R, Fugazza A, et al. Colonic stents for malignant bowel obstruction: current status and future prospects. Expert Rev Med Devices, 2019, 16(12): 1053-1061.
35. Han JG, Wang ZJ, Dai Y, et al. Short-term outcomes of elective surgery following self-expandable metallic stent and neoadjuvant chemotherapy in patients with left-sided colon cancer obstruction. Dis Colon Rectum, 2023, 66(10): 1319-1328.
36. Langell JT, Mulvihill SJ. Gastrointestinal perforation and the acute abdomen. Med Clin North Am, 2008, 92(3): 599-625.
37. Tzivanakis A, Moran BJ. Perforated colorectal cancer. Clin Colon Rectal Surg, 2020, 33(5): 247-252.
38. Kriwanek S, Armbruster C, Dittrich K, et al. Perforated colorectal cancer. Dis Colon Rectum, 1996, 39(12): 1409-1414.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Treatment strategy for the obstructive or perforated rectal cancer

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