Definition of Large Bowel Obstruction by Primary Colorectal Cancer: A Systematic Review

Overview

Journal Colorectal Dis

Specialty Gastroenterology

Date 2020 Dec 11

PMID 33305454

Citations 2

Authors

Joyce V Veld

Kim J Beek

Esther C J Consten

Frank Ter Borg

Henderik L van Westreenen

Wilhelmus A Bemelman

Jeanin E van Hooft

Pieter J Tanis

Affiliations

Soon will be listed here.

Abstract

Aim: Controversies on therapeutic strategy for large bowel obstruction by primary colorectal cancer mainly concern acute conditions, being essentially different from subacute obstruction. Clearly defining acute obstruction is important for design and interpretation of studies as well as for guidelines and daily practice. This systematic review aimed to evaluate definitions of obstruction by colorectal cancer in prospective studies.

Method: A systematic search was performed in PubMed, Embase and the Cochrane Library. Eligibility criteria included randomized or prospective observational design, publication between 2000 and 2019, and the inclusion of patients with an obstruction caused by colorectal cancer. Provided definitions of obstruction were extracted with assessment of common elements.

Results: A total of 16 randomized controlled trials (RCTs) and 99 prospective observational studies were included. Obstruction was specified as acute in 28 studies, complete/emergency in five, (sub)acute or similar terms in four and unspecified in 78. Five of 16 RCTs (31%) and 37 of 99 cohort studies (37%) provided a definition. The definitions included any combination of clinical symptoms, physical signs, endoscopic features and radiological imaging findings in 25 studies. The definition was only based on clinical symptoms in 11 and radiological imaging in six studies. Definitions included a radiological component in 100% of evaluable RCTs (5/5) vs. 54% of prospective observational studies (20/37, P = 0.07).

Conclusion: In this systematic review, the majority of prospective studies did not define obstruction by colorectal cancer and its urgency, whereas provided definitions varied hugely. Radiological confirmation seems to be an essential component in defining acute obstruction.

Citing Articles

CT prognostic signs of postoperative complications in emergency surgery for acute obstructive colonic cancer.

Pezzullo F, Comune R, DAvino R, Mandato Y, Liguori C, Lassandro G Radiol Med. 2024; 129(4):525-535.

PMID: 38512630 DOI: 10.1007/s11547-024-01778-y.

Definition of large bowel obstruction by primary colorectal cancer: A systematic review.

Veld J, Beek K, Consten E, Borg F, van Westreenen H, Bemelman W Colorectal Dis. 2020; 23(4):787-804.

PMID: 33305454 PMC: 8248390. DOI: 10.1111/codi.15479.

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