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©The Author(s) 2025.
World J Clin Oncol. Aug 24, 2025; 16(8): 107757
Published online Aug 24, 2025. doi: 10.5306/wjco.v16.i8.107757
Published online Aug 24, 2025. doi: 10.5306/wjco.v16.i8.107757
Table 1 Surgical strategies in dealing with obstructed colon cancer
Challenges | Mitigation strategies |
Limited working space | Consider proximal decompression at site of intended proximal transection |
e.g., in the case of right-sided cancer with significantly dilated small bowel loops from an incompetent ileocecal valve, an extended periumbilical incision can be made to first perform decompression via a controlled enterotomy extracorporeally at the site of the planned proximal transection (Figure 2), before proceeding with MIS surgery | |
Use gauzes to pack small bowel away and minimize accidental thermal injury to surrounding structures | |
Limited exposure | Adjust patient’s positioning to displace distended bowel away and maximize exposure |
(Consider the use of a surgical table with greater articulating range and patient secured to the table with a surgical bean-bag) | |
Limited access to target anatomy | Work from different approaches (lateral/medial/inferior/supra-colic) and extrapolate from known planes |
Perform dissection distal to obstruction where tissue planes are normal with collapsed bowel. Subsequently perform early distal bowel transection to gain better exposure, before working more proximally |
Table 2 Surgical strategies for perforated colorectal cancer
Challenges | Mitigation strategies |
Limited working space, exposure and access to target anatomy | As per Table 1 |
Difficulty in identifying critical structures and less obvious anatomical planes | Extrapolating from normal tissue planes and known anatomy – there may be a need to start dissection away from the target pathology to identify normal anatomical structures first, before working back towards the pathology by extrapolating from known tissue planes |
Use of adjuncts such as use of lighted ureteric stents or indocyanine green can be helpful | |
Poor optics from surgical smoke and plume generation | Use of intraoperative smoke evacuation systems, or continuous smoke evacuation and carbon dioxide recirculation devices (e.g., AirSeal iFS [CONMED Corp., Largo, FL United States]) to provide more stable pneumoperitoneum pressures and faster clearance of plume |
Reduction of plume generation by keeping dissection planes dry with gauze and frequent suctioning | |
Concerns of adequate decontamination/Lavage in contaminated cases | Use gravity to bring contaminated fluid to more accessible areas with systematic changes to patient positioning |
Use of laparoscopic gauze as a wick when performing suctioning in regions that are harder to gain full exposure | |
Consider the use of laparoscopic suction/irrigation powered pump devices to improve surgical efficiency | |
Friable and inflamed tissue | Heighten awareness on tactile and visual feedback when handling tissues to avoid excessive traction |
Distributing force applied on tissues over a larger surface area by pushing tissues with an open grasper or using a gauze to aid in this. Avoid direct grasping or pulling of tissues as this can easily result in inadvertent injuries | |
Inflamed tissues are more susceptible to bleeding. Performing meticulous hemostasis at all times during the surgery to keep planes dry | |
Control of further intraoperative spillage | Proximal control with laparoscopic bulldog clamp to prevent continued downstream contamination |
Pack defect with gauze | |
If tissue quality is suitable, perform primary closure of the site of perforation as a temporizing measure if added operative time is short |
- Citation: Wong NW, Jabbar SAA, Ngu JCY, Teo NZ. Minimally invasive surgery for colorectal cancer emergencies. World J Clin Oncol 2025; 16(8): 107757
- URL: https://www.wjgnet.com/2218-4333/full/v16/i8/107757.htm
- DOI: https://dx.doi.org/10.5306/wjco.v16.i8.107757