Treatment of Obstructive Colorectal Cancer as an Oncology Emergency

Abstract

Colorectal obstruction caused by cancer, namely obstructive colorectal cancer (OCC), is frequently encountered in routine clinical practice, and often develops as an oncology emergency (OE). In OCC patients, obstruction, perforation due to tumor, abscess or peritonitis, obstructive colitis, and bacterial translocation due to disorder of the intestinal microbial flora are possible morbid conditions at the initial presentation. Therefore, it is necessary to plan decision-making of the initial treatment for the OEs (such as bowel decompression) and the subsequent cancer treatment in a short time, based on evaluation of the oncological curability. The method of bowel decompression should be selected depending on the anticipated subsequent treatment of OCC. It is essential to individually perform multidisciplinary treatment including surgery and chemotherapy, while paying attention to tumor bleeding or perforation related to the treatment. We should keep in mind that OEs may develop during the treatment process of OCC patients, and appropriate measures should be taken. In addition to recent advances in chemotherapy, application of the colonic stent placement as a bridge to surgery and expanded indication of laparoscopic surgery are expected, although long-term prognosis of the treatment has yet to be verified.