Damage control surgical treatment strategy for intestinal obstruction in colorectal cancer patients
Jiang Hua,Sun Mingwei,Cai Bin
Institute for Emergency and Disaster Medicine Sichuan Clinical Research Center for Emergency and Critical Care Sichuan Provincial
People's Hospital Affiliated Hospital of University of Electronic Science and Technology of China Chengdu 610072 Sichuan China
Abstract：Intestinal obstruction is a common complication in colorectal cancer patients and is one of the major causes that result in
emergency services. When patients are admitted to the emergency department their primary tumors are often in advanced stages and
with combined presence of fluid-electrolyte imbalance and malnutrition and they are often in a state of severe metabolic instability. If
patients are not managed properly in time the risk of poor prognosis is extremely high. Traditionally emergency operation is the first
choice in the management of acute intestinal obstruction in such conditions. However in patients with acute malignant intestinal
obstruction the risk of complications and death are significantly higher after emergency operations than elective operations due to the
influences by metabolic instability and the tumor. With the rapid development of the damage control surgery DCS we believe that it
should be introduced to manage patients with acute malignant intestinal obstruction. With technological advances DCS treatment for
malignant intestinal obstruction has become more minimally invasive especially with the application of endoscopic interventions such as
decompression tubes DT and self - expanding metal stents SEMS . These endoscopic advances make emergency operations
unnecessary in most malignant intestinal obstruction patients so elective surgery can be performed after significant improvements in
fluid-electrolytes balance nutritional status and relief of severe inflammatory reactions. In conclusion for colorectal cancer patients
with malignant intestinal obstruction the goal of emergency treatment should be limited to relieve the obstruction rather than radical
resection. Through the comprehensive application of minimally invasive techniques such as SEM DT and nutrition therapy most
patients would not undergone emergency operation and can expect elective surgery in a more stable condition thereby achieving better
clinical outcomes.
