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Background <p>Colorectal cancer (CRC) is a leading cause of cancer mortality, and up to one-third of patients present with obstruction, perforation, or bleeding. Emergency presentation is associated with advanced stage, higher rates of open surgery and stoma formation, and worse survival. This review synthesizes current evidence and provides practical guidance for emergency and acute care management of CRC.</p> Methods <p>We conducted a comprehensive search of MEDLINE and EMBASE for English-language studies from 2000 through July 2025, including randomized trials, meta-analyses, and cohort studies. Data were synthesized by members of the SAGES Colorectal and Acute Care Surgery Committees to identify consensus practices and safe strategies across resource settings.</p> Results <p>Contrast-enhanced CT is the diagnostic cornerstone; endoscopy adds diagnostic and therapeutic value when feasible. For right-sided cancers, oncologic right colectomy with primary anastomosis is generally safe in obstruction and selected perforations; diversion or staged surgery is preferred in unstable or contaminated fields. For left-sided obstruction, options include Hartmann’s procedure, resection with primary anastomosis (± diversion), loop colostomy, or self-expandable metal stents (SEMS). SEMS provide effective decompression and enable minimally invasive interval resection with lower stoma rates when available. Perforation requires individualized strategies based on contamination; Hartmann’s procedure and subtotal colectomy are commonly employed. In rectal cancer, emergency care should prioritize stabilization, decompression, biopsy, and facilitation of neoadjuvant therapy rather than immediate resection.</p> Conclusions <p>Optimal emergency CRC care requires rapid diagnosis, oncologic principles, and individualized operative planning. Bridge-to-surgery strategies, selective diversion, and judicious use of minimally invasive techniques can reduce morbidity, expedite oncologic therapy, and improve outcomes.</p>

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Clinical spotlight review: best practices for the management of colorectal cancer in the emergency and acute care setting

  • 期刊论文

  • 发表日期：

    2026年5月28日

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  • Patricia Tejedor,
  • Carlos Pastor,
  • Antonio Caycedo‑Marulanda,
  • Mark Whiteford,
  • Elisabeth C. McLemore,
  • Patricia Sylla,
  • Marylise Boutros,
  • Nawar A. Alkhamesi

摘要

Background

Colorectal cancer (CRC) is a leading cause of cancer mortality, and up to one-third of patients present with obstruction, perforation, or bleeding. Emergency presentation is associated with advanced stage, higher rates of open surgery and stoma formation, and worse survival. This review synthesizes current evidence and provides practical guidance for emergency and acute care management of CRC.

Methods

We conducted a comprehensive search of MEDLINE and EMBASE for English-language studies from 2000 through July 2025, including randomized trials, meta-analyses, and cohort studies. Data were synthesized by members of the SAGES Colorectal and Acute Care Surgery Committees to identify consensus practices and safe strategies across resource settings.

Results

Contrast-enhanced CT is the diagnostic cornerstone; endoscopy adds diagnostic and therapeutic value when feasible. For right-sided cancers, oncologic right colectomy with primary anastomosis is generally safe in obstruction and selected perforations; diversion or staged surgery is preferred in unstable or contaminated fields. For left-sided obstruction, options include Hartmann’s procedure, resection with primary anastomosis (± diversion), loop colostomy, or self-expandable metal stents (SEMS). SEMS provide effective decompression and enable minimally invasive interval resection with lower stoma rates when available. Perforation requires individualized strategies based on contamination; Hartmann’s procedure and subtotal colectomy are commonly employed. In rectal cancer, emergency care should prioritize stabilization, decompression, biopsy, and facilitation of neoadjuvant therapy rather than immediate resection.

Conclusions

Optimal emergency CRC care requires rapid diagnosis, oncologic principles, and individualized operative planning. Bridge-to-surgery strategies, selective diversion, and judicious use of minimally invasive techniques can reduce morbidity, expedite oncologic therapy, and improve outcomes.