NYMC Faculty Publications

Surgical Decision-Making in Emergency Management of Colon and Rectal Malignancies

DOI

10.1007/978-3-031-67391-7_20

Journal Title

Surgical Decision Making Evidence and Beyond Second Edition

First Page

233

Last Page

243

Document Type

Article

Publication Date

1-1-2025

Department

Surgery

Keywords

Bleeding, Colon cancer, Emergency, Local invasion, Obstruction, Perforation, Rectal cancer, Stent

Disciplines

Medicine and Health Sciences

Abstract

Colorectal cancer remains a significant global health concern, especially with its increasing incidence among younger patients. Efforts to address this issue include enhanced screening protocols, yet many patients still present with symptomatic disease requiring urgent surgical intervention. Balancing the urgency of surgical intervention with adherence to established guidelines, such as those from the National Comprehensive Cancer Network (NCCN), is crucial in managing these patients effectively. Key principles in surgical management include ensuring sufficient margins, performing adequate lymphadenectomy, considering the necessity of stoma creation, and planning for adjuvant therapies as appropriate. Surgical approaches should encompass thorough mobilization and vascular ligation techniques, with consideration for managing intraoperative complications like perforation, local invasion, and carcinomatosis. With the demonstrated benefits of neoadjuvant therapies in locally advanced rectal cancers, upfront resection should be deferred if possible, except in cases of perforation into the peritoneal cavity where immediate intervention may be necessary. Additionally, colonic stent placement can be a valuable tool for relieving obstruction in cases of non-perforated malignancies, providing a bridge to definitive treatment. Overall, this multifaceted approach underscores the importance of a comprehensive strategy in managing colorectal cancer, integrating surgical expertise with advances in neoadjuvant therapies and supportive interventions to optimize patient.

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