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World J Gastrointest Oncol. Dec 15, 2021; 13(12): 1850-1862
Published online Dec 15, 2021. doi: 10.4251/wjgo.v13.i12.1850
Management of obstructive colon cancer: Current status, obstacles, and future directions
Ri-Na Yoo, Hyeon-Min Cho, Bong-Hyeon Kye
Ri-Na Yoo, Hyeon-Min Cho, Bong-Hyeon Kye, Division of Colorectal Surgery, Department of Surgery, St. Vincent’s Hospital, The Catholic University of Korea, Suwon 442-723, South Korea
Author contributions: Yoo RN, Cho HM and Kye BH were involved equally and have read and approved the final manuscript; Yoo R, Cho HM, and Kye BH met the criteria for authorship established by the International Committee of Medical Journal Editors and verified the validity of the results reported.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bong-Hyeon Kye, MD, PhD, Associate Professor, Surgeon, Surgical Oncologist, Division of Colorectal Surgery, Department of Surgery, St. Vincent’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Suwon 442-723, South Korea. ggbong@catholic.ac.kr
Received: March 20, 2021
Peer-review started: March 20, 2021
First decision: July 3, 2021
Revised: July 7, 2021
Accepted: September 22, 2021
Article in press: September 22, 2021
Published online: December 15, 2021
Processing time: 269 Days and 17.1 Hours
Abstract

Approximately 10%–18% of patients with colon cancer present with obstruction at the initial diagnosis. Despite active screening efforts, the incidence of obstructive colon cancer remains stable. Traditionally, emergency surgery has been indicated to treat patients with obstructive colon cancer. However, compared to patients undergoing elective surgery, the morbidity and mortality rates of patients requiring emergency surgery for obstructive colon cancer are high. With the advancement of colonoscopic techniques and equipment, a self-expandable metal stent (SEMS) was introduced to relieve obstructive symptoms, allowing the patient’s general condition to be restored and for them undergo elective surgery. As the use of SEMS placement is growing, controversies about its application in potentially curable diseases have been raised. In this review, the short- and long-term outcomes of different treatment strategies, particularly emergency surgery vs SEMS placement followed by elective surgery in resectable, locally advanced obstructive colon cancer, are described based on the location of the obstructive cancer lesion. Controversies regarding each treatment strategy are discussed. To overcome current obstacles, a potential diagnostic method using circulating tumor DNA and further research directions incorporating neoadjuvant chemotherapy are introduced.

Keywords: Colonic neoplasms; Self-expandable metallic stents; Intestinal obstruction; Survival rate; Morbidity; Mortality

Core Tip: The optimal management of obstructive colon cancer remains intricate and controversial, particularly now that the use of colonoscopic stents is expanding. Several studies have demonstrated the better short-term outcome achieved by delayed surgery after self-expandable metal stent (SEMS) placement than emergency surgery. However, concerns that SEMS placement diminishes oncologic outcomes have been increasing. This article summarizes the impact of SEMS placement in managing obstructive colon cancer and suggests future research to resolve current problems.