Management of Obstructed Colorectal Cancer: Review Article

Abstract

Colorectal cancer (CRC) represents a major global health burden, ranking as the third most common malignancy in men and the second in women worldwide. In 2020, over 1.9 million new cases and 930,000 CRC-related deaths occurred globally, with significant geographical variations in incidence and mortality. Approximately 7–29% of CRC patients present with acute large bowel obstruction, a life-threatening emergency that confers significantly worse prognosis compared to non-obstructed cases, with 5-year survival rates below 29%. These patients frequently present with locally advanced disease, perforation, adjacent organ invasion, or metastatic dissemination. Emergency colorectal procedures are associated with higher morbidity and mortality rates, particularly in elderly and frail populations, creating complex surgical decision-making challenges. The optimal management strategy whether primary resection with anastomosis, resection with stoma formation (Hartmann procedure), or diversion alone remains controversial despite decades of clinical experience. Recent advances including endoscopic stenting as a bridge to surgery, laparoscopic approaches, and evolving guidelines from major surgical societies have added further complexity to treatment algorithms. The selection of surgical modality must balance oncological principles with patient safety, hemodynamic stability, disease stage, and available expertise, making individualized, multidisciplinary decision-making essential for optimizing outcomes in this challenging patient population.