Minimally invasive surgery for colorectal cancer emergencies

Abstract

Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality globally, and its management in the emergency setting presents distinct challenges. In addition to its advantages in elective CRC surgery, studies have demonstrated that minimally invasive surgery (MIS) can provide benefits in CRC emergencies, such as reduced morbidity and a shorter length of hospitalization. However, the applicability of MIS in the emergency setting is limited by factors such as compromised patient physiology, resource constraints, and the need for technical expertise. As an alternative to emergency MIS, endoscopic interventions have also been increasingly supported by emerging evidence as a bridge to surgery. This article appraises contemporary guidelines and the evidence behind their recommendations for MIS surgery in CRC emergencies, whilst highlighting the challenges to implementation and the strategies to overcome them.

Keywords: Colorectal malignancy; Colorectal cancer emergency; Minimally invasive surgery; Laparoscopic; Robotic; Obstructed colorectal cancer; Perforated colorectal cancer; Bleeding colorectal cancer

Core Tip: The management of colorectal cancer in the emergency setting presents distinct challenges. Despite its merits, the applicability of minimally invasive surgery in the emergency setting is limited by factors such as compromised patient physiology, resource constraints, and the need for technical expertise. We discuss our approaches to various colorectal emergencies, critically evaluating available literature, examining the challenges and strategies to overcome them with the goal of increasing minimally invasive surgery penetrance in the management of these conditions.