Decision-making in emergency colorectal surgery for cancer

Colorectal cancer (CRC) is the most common gastrointestinal (GI) malignancy and the second most common cause of cancer-related death. Emergency presentations constitute about 20% of admissions for CRC. The article discusses the current arguments and evidence that drive decision-making in emergency colorectal surgery for complications (obstruction, perforation, and bleeding) of CRC. The goal of the surgeon is to control in-hospital mortality, local recurrence of CRC, and quality of life. An electronic literature search of the MEDLINE (PubMed) database, Cochrane Library, and Science Citation Index was performed to identify original published studies on CRC emergencies and their management. The findings are that the timeliness and adequacy of management of CRC complications depend on an interaction between patient-, disease-, and surgeon-related factors. In perforated CRC, short-term survival is determined by sepsis. The empirical surgical intervention in emergency colorectal surgery for malignancy is determined by the patient's status and the disease.