Obstructed colon cancer: Review and perspectives

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Obstructed colon cancer (OCC) presents a significant challenge, accounting for 25% of colorectal cancer diagnoses.
• It necessitates managing acute colonic obstruction and treating advanced malignancy, often in frail patients.

Purpose of the Study:

• To review current management strategies for obstructed colon cancer.
• To highlight the need for novel treatment approaches, including neoadjuvant chemotherapy.

Main Methods:

• Review of surgical approaches for right-sided and left-sided OCC.
• Discussion of alternative strategies like colonic stenting and bowel-preserving surgery.
• Exploration of neoadjuvant chemotherapy in the context of surgical intervention.

Main Results:

• Right-sided OCC: Right hemicolectomy or ileostomy as a bridge to colectomy.
• Left-sided OCC: Diverting colostomy for staging and optimization before colectomy.
• Alternative options include colonic stenting and bowel-preserving surgery for specific cases.

Conclusions:

• Emergency surgery for OCC has high morbidity and can delay adjuvant chemotherapy.
• Neoadjuvant chemotherapy during the interval between initial intervention and colectomy is a promising novel strategy.
• Improved treatment strategies are warranted due to the poor prognosis of OCC.