J.Jpn. Surg. Soc.. 105(4): 286-291, 2004

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Feature topic

ONCOLOGIC EMERGENCIES IN COLORECTAL CANCER PATIENTS

The management of obstruction and perforation, which are representative of primary oncologic emergencies in colorectal cancer patients, is outlined. In the management of obstructing colorectal carcinoma, primary resection and anastomosis can be performed in elective conditions with favorable outcomes with preoperative decompression of the obstruction using decompression tubes or self-expanding stents and is the treatment of choice. Even in patients in whom the obstruction fails to improve, the current trend favors intraoperative on table lavage followed by primary resection and anastomosis, except when patients are hemodynamically unstable during surgery or when the condition of the bowel is not optimal for primary anastomosis.
For patients with colorectal perforation, the treatment of first choice is primary resection of the septic focus at the perforation site plus colostomy. Single-stage surgery (primary anastomosis after resection of the perforation site) or primary resection of the tumor in patients with peforation occurring far proximal to the cancer should be avoided to reduce the risk of postoperative complications, especially in patients with serious conditions. Intensive management to prevent sepsis including continuous blood purification methods such as polymixin B-immobilized fiber hemofiltration and continuous hemodiafiltration is required to improve the perioperative mortality rate.

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