[Bowel preparation before elective surgery for colorectal cancer]

Area of Science:

• Colorectal Surgery
• Gastroenterology
• Oncology

Background:

• Current evidence supports mechanical bowel preparation with oral antibiotics for elective colorectal cancer surgery.
• Patients with intestinal stenosis require individualized protocols to prevent adverse events.
• Updates in guidelines and consensus necessitate a review of current practices.

Purpose of the Study:

• To summarize recent high-quality evidence and guideline updates on preoperative bowel preparation for colorectal cancer.
• To propose an evidence-based, individualized, and stratified bowel preparation protocol.
• To improve perioperative outcomes and reduce adverse events in colorectal cancer patients.

Main Methods:

• Review of recent high-quality evidence, guidelines, and consensus statements.
• Development of a stratified bowel preparation protocol based on clinical practice.
• Categorization of patients based on oral intake, colonoscopy feasibility, and presence of bowel obstruction.

Main Results:

• For patients with unimpaired oral intake and passable tumors: mechanical bowel preparation and oral antibiotics.
• For patients with impaired oral intake or stenosis (no obstruction): low-dose laxatives for several days and oral antibiotics the day before surgery.
• For patients with bowel obstruction: mechanical bowel preparation or enema is contraindicated.

Conclusions:

• An individualized, stratified preoperative bowel preparation protocol is proposed for colorectal cancer surgery.
• This protocol aims to optimize patient management based on specific clinical scenarios, including stenosis and obstruction.
• The proposed strategy is expected to enhance perioperative outcomes and minimize complications.