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Surgical approach for acute colon tumor obstruction in elderly and octogenarian patients (review)

https://doi.org/10.33878/2073-7556-2025-24-1-135-144

Abstract

Acute bowel obstruction is the most common complication of left colon cancer, with the age of patients with this pathology in most cases being over 75 years. The optimal surgical approach in this group of patients remains debatable. A search of scientific studies on the treatment of left-sided malignant obstruction in elderly and octogenarian patients was done in the Elibrary.ru, PubMed, and Medline databases from 2008 to 2023. To date, there is no irrefutable evidence to support whether emergency surgery or colonic stent placement is optimal treatment in terms of the morbidity, mortality and late oncological outcomes. A current solution to the problem can be temporary decompression of the bowel. The literature demonstrates advantages of diverting colostomy at the first stage in decrease in perioperative mortality, an improvement in the quality of life due to a decreased morbidity and mortality rate, good oncological.

About the Authors

A. G. Efron
Smolensk State Medical University ; Smolensk Regional Oncology Clinical Hospital
Russian Federation

Aleksandr G. Efron 

Krupskaya st., 28, Smolensk, 214019 

Marshal Zhukov st., 19, Smolensk 214000 



S. N. Shchaeva
Smolensk State Medical University ; Multidisciplinary clinic “Uromed”
Russian Federation

Svetlana N. Shchaeva 

Krupskaya st., 28, Smolensk, 214019 

Marshal Sokolovsky st., 18/1, Smolensk, 214031 



L. I. Volynets
Smolensk State Medical University ; Smolensk Regional Clinical Hospital
Russian Federation

Larisa I. Volynets 

Krupskaya st., 28, Smolensk, 214019 

Gagarin st., 27, Smolensk, 214018 



References

1. Biondo S, Gálvez A, Ramírez E. et al. Emergency surgery for obstructing and perforated colon cancer: patterns of recurrence and prognostic factors. Tech Coloproctol. 2019 Dec;23(12):1141–1161. doi: 10.1007/s10151-019-02110-x

2. Zhou H, Jin Y, Wang J, et al. Comparison of short-term surgical outcomes and long-term survival between emergency and elective surgery for colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis. 2023 Feb 15;38(1):41. doi: 10.1007/s00384-023-04334-8

3. Danzi M, Grimaldi L, De Capua M, et al. Obstructing left sided colorectal cancer. A retrospective single Center study. Ann Ital Chir. 2019;90:121–126. PMID: 30569909.

4. Kronborg O. Acute obstruction from tumor in the left colon without spread. A randomized trial of emergency colostomy versus resection. Int J Colorectal Dis. 1995;10(1):1–5. doi: 10.1007/BF00337576

5. Sjo OH, Larsen S, Lunde OC, et al. Short term outcome after emergency and elective surgery for colon cancer. Colorectal Dis. 2009 Sep;11(7):733–9. doi: 10.1111/j.1463-1318.2008.01613.x

6. Negruț RL, Coțe A, Maghiar AM. A Retrospective analysis of emergency versus elective surgical outcomes in colon cancer patients: A Single-Center Study. J Clin Med. 2024 Oct 30;13(21):6533. doi: 10.3390/jcm13216533

7. Baer C, Menon R, Bastawrous S, et al. Emergency presentations of colorectal cancer. Surg Clin North Am. 2017 Jun;97(3):529–545. doi: 10.1016/j.suc.2017.01.004

8. Kato H, Kawai K, Nakano D, et al. Does colorectal stenting as a bridge to surgery for obstructive colorectal cancer increase perineural invasion? J Anus Rectum Colon. 2024 Jul 30;8(3):195–203. doi: 10.23922/jarc.2023-057

9. Bakker IS, Snijders HS, Grossmann I, et al. High mortality rates after nonelective colon cancer resection: results of a national audit. Colorectal Dis. 2016 Jun;18(6):612–21. doi: 10.1111/codi.13262

10. Nilssen Y, Eriksen MT, Guren MG, et al. Factors associated with emergency-onset diagnosis, time to treatment and type of treatment in colorectal cancer patients in Norway. BMC Cancer. 2021 Jun 30;21(1):757. doi: 10.1186/s12885-021-08415-1

11. Achkasov S.I., Bagatelia Z.A., Bagnenko S.F. et al. Acute malignant colorectal obstruction (K56.6; C18, C19, C20), adults. Koloproktologia. 2023;22(2):10–31. (In Russ.). doi: 10.33878/2073-7556-2023-22-2-10-31

12. Shabunin A.V., Bagateliya Z.A., Gugnin A.V. Implementation of multistage approach for colorectal cancer with bowel obstruction in surgeon units of Moscow. Koloproktologia. 2018;(4):7–15. (In Russ.). doi: 10.33878/2073-7556-2018-0-4-7-15

13. Pugaev A.V., Achkasov E.E. Obturative colonic obstruction of tumor. Moscow: «Scientific Publishing Center INFRA-M». 2019; 170 p. (In Russ.).

14. Shchaeva S.N. Analysis of survival in complicated colorectal cancer. Oncological Coloproctology. 2017;7(2):20–29. (In Russ.)].

15. Pisano M, Zorcolo L, Merli C, et al. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg. 2018 Aug 13;13:36. doi: 10.1186/s13017-018-0192-3

16. Mazzotta AD, Burti E, Causio FA, et al. Machine learning approaches for the prediction of postoperative major complications in patients undergoing surgery for bowel obstruction. J Pers Med. 2024 Oct 8;14(10):1043. doi: 10.3390/jpm14101043

17. Ebell MH, Thai TN, Royalty KJ. Cancer screening recommendations: an international comparison of high-income countries. Public Health Rev. 2018 Mar 2;39:7. doi: 10.1186/s40985-018-0080-0

18. Shabunin A.V., Bagateliya Z.A. Algorithm of surgical care in complicated colorectal cancer. Koloproktologia. 2019;18(1):66–73. (In Russ.)].

19. Balciscueta I, Balciscueta Z, Uribe N, et al. Perineural invasion is increased in patients receiving colonic stenting as a bridge to surgery: a systematic review and meta-analysis. Tech Coloproctol. 2021 Feb;25(2):167–176. doi: 10.1007/s10151-020-02350-2

20. Berselli M, Borroni G, Livraghi L, et al. Laparoscopic approach to large bowel neoplastic obstruction after self-expandable-metalstent (sems) placement. Surg Laparosc Endosc Percutan Tech. 2019 Apr;29(2):133–137. doi: 10.1097/SLE.0000000000000623

21. Catena F, De Simone B, Coccolini F, et al. Bowel obstruction: a narrative review for all physicians. World J Emerg Surg. 2019 Apr 29;14:20. doi: 10.1186/s13017-019-0240-7

22. Trigui A, Rejab H, Akrout A, et al. Comparaison entre stent endoscopique et colostomie pour les cancers coliques gauches en occlusion: revue de la littérature [Comparison between endoscopic stenting and colostomy in the management of obstructing cancer of the left colon: Literature review]. Presse Med. 2019 Feb;48(2):173–180. French. doi: 10.1016/j.lpm.2019.01.007

23. Zavrazhnov A.A., Solovyov I.A., Pavelets K.V., et al. Multistage surgical treatment of a patient with sigmoid colon cancer complicated by suprastenotic ruptures of the colon wall far from the tumor. Bulletin of the N.I. Pirogov National Medical and Surgical Center. 2022;17(3):148–149(In Russ.). doi: 10.25881/20728255_2022_17_3_148

24. Shelygin Yu.A., Muratov I.I., Sushkov O.I., et al. Quality of life after extended lymph node dissection for colon cancer. Koloproktologia. 2021;20(2):17–28. (In Russ.). doi: 10.33878/2073-7556-2021-20-2-17-28

25. Muldoon RL. Malignant Large Bowel Obstruction. Clin Colon Rectal Surg. 2021 Jul;34(4):251–261. doi: 10.1055/s-0041-1729922

26. Manceau G, Mege D, Bridoux V, et al. French surgical association working group. Emergency surgery for obstructive colon cancer in elderly patients: results of a multicentric cohort of the French national surgical association. Dis Colon Rectum. 2019 Aug;62(8):941–951. doi: 10.1097/DCR.0000000000001421

27. GBD 2017 Colorectal Cancer Collaborators. The global, regional, and national burden of colorectal cancer and its attributable risk factors in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2019 Dec;4(12):913–933. doi: 10.1016/S2468-1253(19)30345-0

28. Kalev G, Marquardt C, Schiedeck T. Stomaassoziierte Komplikationen — Vermeidungsstrategie und Therapiekonzepte [Stoma-associated complications-Prevention strategy and treatment concepts]. Chirurg. 2022 Apr;93(4):415–426. German. doi: 10.1007/s00104-021-01438-1

29. Govaert JA, Fiocco M, van Dijk WA, et al.; Dutch Value Based Healthcare Study Group. Costs of complications after colorectal cancer surgery in the Netherlands: Building the business case for hospitals. Eur J Surg Oncol. 2015 Aug;41(8):1059–67. doi: 10.1016/j.ejso.2015.03.236

30. Goldsbury DE, Feletto E, Weber MF, et al. Health system costs and days in hospital for colorectal cancer patients in New South Wales, Australia. PLoS One. 2021 Nov 29;16(11):e0260088. doi: 10.1371/journal.pone.0260088

31. Meisner S, Lehur PA, Moran B, et al. Peristomal skin complications are common, expensive, and difficult to manage: a population-based cost modeling study. PLoS One. 2012;7(5):e37813. doi: 10.1371/journal.pone.0037813

32. Jain SR, Yaow CYL, Ng CH, et al. Comparison of colonic stents, stomas and resection for obstructive left colon cancer: a meta-analysis. Tech Coloproctol. 2020 Nov;24(11):1121–1136. doi: 10.1007/s10151-020-02296-5

33. Totikov Z.V., Totikov V.Z., Remizov O.V. et al. Optimal diagnostic algorithm for colorectal cancer complicated by acute bowel obstruction. Koloproktologia. 2020;19(3):72–79. (In Russ.). doi: 10.33878/2073-7556-2020-19-3-72-79

34. Veld JV, Amelung FJ, Borstlap WAA. et al. Dutch Snapshot Research Group. Decompressing Stoma as Bridge to Elective Surgery is an Effective Strategy for Left-sided Obstructive Colon Cancer: A National, Propensity-score Matched Study. Ann Surg. 2020 Nov;272(5):738–743. doi: 10.1097/SLA.0000000000004173 PMID: 32833768.

35. Mege D, Sabbagh C, Manceau G, et al. AFC (French Surgical Association) Working Group. What is the best option between primary diverting stoma or endoscopic stent as a bridge to surgery with a curative intent for obstructed left colon cancer? Results from a propensity score analysis of the French surgical association multicenter cohort of 518 patients. Ann Surg Oncol. 2019 Mar;26(3):756–764. doi: 10.1245/s10434-018-07139-0

36. Amelung FJ, Mulder CL, Verheijen PM, et al. Acute resection versus bridge to surgery with diverting colostomy for patients with acute malignant left sided colonic obstruction: Systematic review and meta-analysis. Surg Oncol. 2015 Dec;24(4):313–21. doi: 10.1016/j.suronc.2015.10.003

37. Kawachi J, Kashiwagi H, Shimoyama R, et al. Comparison of efficacies of the self-expandable metallic stent versus transanal drainage tube and emergency surgery for malignant left-sided colon obstruction. Asian J Surg. 2018 Sep;41(5):498–505. doi: 10.1016/j.asjsur.2017.06.003

38. Matsuda A, Yamada T, Matsumoto S, et al. Short-term outcomes of a self-expandable metallic stent as a bridge to surgery vs. a transanal decompression tube for malignant large-bowel obstruction: a meta-analysis. Surg Today. 2019 Sep;49(9):728–737. doi: 10.1007/s00595-019-01784-y

39. Chen Y, Fan Z, Zhao L. The role of colonic stents in extracolonic malignant large-bowel obstruction. Gastrointest Endosc. 2019 Feb;89(2):441. doi: 10.1016/j.gie.2018.08.016

40. Donlon NE, Kelly ME, Narouz F, et al. Colonic stenting as a bridge to surgery in malignant large bowel obstruction: oncological outcomes. Int J Colorectal Dis. 2019 Apr;34(4):613–619. doi: 10.1007/s00384-019-03239-9

41. Hohenberger W, Weber K, Matzel K, et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation- -technical notes and outcome. Colorectal Dis. 2009 May;11(4):354– 64; discussion 364-5. doi: 10.1111/j.1463-1318.2008.01735.x

42. Mothes H, Bauschke A, Schuele S, et al. Surgery for colorectal cancer in elderly patients: how can we improve outcome? J Cancer Res Clin Oncol. 2017 Sep;143(9):1879–1889. doi: 10.1007/s00432-017-2438-y

43. Tabola R, Mantese G, Cirocchi R, et al. Postoperative mortality and morbidity in older patients undergoing emergency right hemicolectomy for colon cancer. Aging Clin Exp Res. 2017 Feb;29(Suppl 1):121–126. doi: 10.1007/s40520-016-0643-1

44. De Simone B, Coccolini F, Ansaloni L. et al. Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency? Ulus Travma Acil Cerrahi Derg. 2017 Jan;23(1):15–22. doi: 10.5505/tjtes.2016.77178

45. Schlichtemeier S, Logaraj A, Gill AJ, et al. Colorectal cancer resection in the Australian nonagenarian patient. Colorectal Dis. 2017 Mar;19(3):243–250. doi: 10.1111/codi.13434

46. Pirrera B, Vaccari S, Cuicchi D, et al. Impact of octogenarians on surgical outcome in colorectal cancer. Int J Surg. 2016 Nov;35:28– 33. doi: 10.1016/j.ijsu.2016.09.006

47. Ming-Gao G, Jian-Zhong D, Yu W, et al. Colorectal cancer treatment in octogenarians: elective or emergency surgery? World J Surg Oncol. 2014 Dec 17;12:386. doi: 10.1186/1477-7819-12-386

48. Kolfschoten NE, Wouters MW, Gooiker GA, et al. Dutch Surgical Colorectal Audit group. Nonelective colon cancer resections in elderly patients: results from the dutch surgical colorectal audit. Dig Surg. 2012;29(5):412–9. doi: 10.1159/000345614

49. Iversen LH, Bülow S, Christensen IJ, et al. Danish Colorectal Cancer Group. Postoperative medical complications are the main cause of early death after emergency surgery for colonic cancer. Br J Surg. 2008 Aug;95(8):1012–9. doi: 10.1002/bjs.6114

50. Na JE, Kim ER, Kim JE, et al. The optimal surgery timing after stenting in colorectal cancer patients with malignant obstruction: additionally compared with emergency surgery. World J Surg Oncol. 2023 Aug 23;21(1):259. doi: 10.1186/s12957-023-03130-6


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For citations:


Efron A.G., Shchaeva S.N., Volynets L.I. Surgical approach for acute colon tumor obstruction in elderly and octogenarian patients (review). Koloproktologia. 2025;24(1):135-144. https://doi.org/10.33878/2073-7556-2025-24-1-135-144

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