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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).
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.
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.
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.
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.
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.
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.
摘要：
结直肠癌引起的梗阻和穿孔在诊断方面具有挑战性，拯救生命的策略,阻塞解决和肿瘤挑战。本论文的目的是更新先前的WSES指南，以治疗大肠穿孔和阻塞性左结肠癌（OLCC），并制定新的阻塞性右结肠癌（ORCC）指南。
在2017年12月之前，文献被广泛查询为重点出版物。由专家组成的工作组对文献进行了精确的分析和分级：提出了陈述和文献综述，在2017年5月在坎皮纳斯举行的世界急诊外科学会（WSES）第四届大会共识会议上进行了讨论和投票。
CT扫描是评估大肠梗阻和穿孔的最佳成像技术。对于OLCC，自膨式金属支架(SEMS),当可用时,与急诊手术相比，提供了有趣的优势；然而，SEMS对可手术治疗原因的定位带有一些长期的肿瘤学缺点，仍在分析中。在急诊手术中,切除和原发性吻合术(RPA)优于哈特曼手术，只要患者和外科医生的特征是允许的。在直肠癌中，右侧环形结肠造口术是优选的，当预测术前治疗时。关于ORCC的治疗，右结肠切除术代表选择的程序；替代方案，如内部旁路和回肠环形造口术，价值有限。穿孔的临床情况可能是戏剧性的，尤其是在游离粪便性腹膜炎的情况下。必须强调在挽救生命的外科手术和尊重肿瘤警告之间取得适当平衡的重要性。在某些情况下，可能需要一种损伤控制方法。药物治疗包括适当的液体复苏，根据国际指南,所有患者必须在就诊时接受早期抗生素治疗和共存疾病管理.
目前的指南提供了关于结直肠癌引起的大肠梗阻和穿孔治疗的现有证据和定性共识的广泛概述。
在2017年12月之前，文献被广泛查询为重点出版物。由专家组成的工作组对文献进行了精确的分析和分级：提出了陈述和文献综述，在2017年5月在坎皮纳斯举行的世界急诊外科学会（WSES）第四届大会共识会议上进行了讨论和投票。
CT扫描是评估大肠梗阻和穿孔的最佳成像技术。对于OLCC，自膨式金属支架(SEMS),当可用时,与急诊手术相比，提供了有趣的优势；然而，SEMS对可手术治疗原因的定位带有一些长期的肿瘤学缺点，仍在分析中。在急诊手术中,切除和原发性吻合术(RPA)优于哈特曼手术，只要患者和外科医生的特征是允许的。在直肠癌中，右侧环形结肠造口术是优选的，当预测术前治疗时。关于ORCC的治疗，右结肠切除术代表选择的程序；替代方案，如内部旁路和回肠环形造口术，价值有限。穿孔的临床情况可能是戏剧性的，尤其是在游离粪便性腹膜炎的情况下。必须强调在挽救生命的外科手术和尊重肿瘤警告之间取得适当平衡的重要性。在某些情况下，可能需要一种损伤控制方法。药物治疗包括适当的液体复苏，根据国际指南,所有患者必须在就诊时接受早期抗生素治疗和共存疾病管理.
目前的指南提供了关于结直肠癌引起的大肠梗阻和穿孔治疗的现有证据和定性共识的广泛概述。
