Emergency surgery for malignant large bowel obstruction - Assessing management options and outcomes - Editorial

Sep 22, 2026

Malignant large bowel obstruction accounts for a disproportionate share of colorectal cancer emergencies. Traditionally managed by emergency surgery, treatment decisions often involve primary resection or staged approaches, but are linked with considerable morbidity and mortality. The editorial evaluates a study by Qiu et al that proposes a nomogram benchmark for recurrence prediction, while highlighting limitations in short follow-up, tumor heterogeneity, and the need to assess model performance across multiple time horizons. It also emphasizes the growing role of self-expanding metal stents, and the importance of distinguishing residual disease from recurrence.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Editorial

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| W | J | G | S | World Journal of
Gastrointestinal Surgery | | --- | --- | --- | --- | --- | Submit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Gastrointest Surg 2026 February 27; 18(2): 113867 DOI: 10.4240/wjgs.v18.i2.113867 ISSN 1948-9366 (online) EDITORIAL Emergency surgery for malignant large bowel obstruction: Assessing management options and outcomes Terence N Moyana Provenance and peer review: Invited article; Externally peer reviewed. Peer-review model: Single blind Peer-review report’s classification Scientific Quality: Grade B, Grade C, Grade D, Grade D Novelty: Grade C, Grade C, Grade C, Grade D Creativity or Innovation: Grade C, Grade C, Grade C, Grade D Scientific Significance: Grade B, Grade C, Grade D, Grade D P-Reviewer: Kehagias D, PhD, Greece; Topcu R, Associate Professor, Türkiye Received: September 5, 2025 Revised: November 11, 2025 Accepted: December 3, 2025 Published online: February 27, 2026 Processing time: 174 Days and 15.8 Hours ©Author(s) (or their employer(s)) 2026. No commercial re-use. See Permissions. Published by Baishideng Publishing Group Inc. Terence N Moyana, Division of Diagnostic and Molecular Pathology, The Ottawa Hospital and University of Ottawa, Ottawa K1H 8L6, Ontario, Canada ORCID number: Terence N Moyana 0009-0006-8426-8638. Corresponding author: Terence N Moyana, MD, FRCPC, FCAP, Full Professor, Division of Diagnostic and Molecular Pathology, The Ottawa Hospital and University of Ottawa, 501 Smyth Road, Ottawa K1H 8L6, Ontario, [Canada.](Canada. tmoyana@toh.ca)[ tmoyana@toh.ca](Canada. tmoyana@toh.ca) Abstract Malignant large bowel obstruction accounts for a disproportionately high percentage of colorectal cancer emergencies. Traditionally, it was treated by emergency surgery, which, depending on the circumstances, could involve primary resection or staged procedures. However, this was associated with considerable morbidity and mortality. Qiu et al sought to improve this by creating a nomogram that can be used as a benchmark in the management of such patients. Although the nomogram is meant to be a predictive model for recurrence, it is only based on a snapshot of parameters at 2 years. To be of maximum benefit to patients consenting for surgery and their caregivers, the performance of the model should be assessed over both the short-and long-term intervals (e.g., 30, 60, and 90 days as well as 1, 2, and 5 years or longer) . Moreover, the heterogeneity of colorectal cancer (e.g., right-sided vs left-sided cancers vs rectal cancers) limits the nomogram’s applicability in certain situations, as it was constructed using a onesize-fits-all approach. It is also noteworthy that the increasing acceptance of selfexpanding metal stents as an option to emergency surgery provides significant benefits for patients with malignant large bowel obstruction. Lastly, it is important to distinguish residual disease from recurrence, as conflating the two may confound parameters and study endpoints. This distinction has gained renewed interest with recent advances in liquid biopsies and genomics and how they can better define minimal residual disease. Key Words: Malignant large bowel obstruction; Emergency surgery; Disease recurrence; Self-expanding metal stents; Bridge-to-surgery; Right vs left colon cancer; Molecular biomarkers [https://dx.doi.org/10.4240/wjgs.v18.i2.113867](https://dx.doi.org/10.4240/wjgs.v18.i2.113867) 1 February 27, 2026 Volume 18 Issue 2 Moyana TN. Options for malignant large bowel obstruction Core Tip: Malignant large bowel obstruction was traditionally managed by emergency surgery, a strategy associated with considerable morbidity and mortality. The introduction of self-expanding metal stents in the 1990s provided an option to emergency surgery with significant benefits for these patients. Looking ahead, advances in liquid biopsies and molecular biomarkers are poised to enhance

FAQs

How is malignant large bowel obstruction traditionally managed, and what are the major drawbacks?

It has traditionally been managed with emergency surgery, which can involve primary resection or staged procedures. The approach is associated with substantial morbidity and mortality.

What does the nomogram by Qiu et al aim to do, and what limitation is noted?

The nomogram is designed as a benchmark to predict recurrence, using parameters assessed at surgery. Its performance is limited by being based on a snapshot at 2 years.

Why are self-expanding metal stents considered an important option in this context?

Increasing acceptance of self-expanding metal stents provides significant benefits for patients with malignant large bowel obstruction, offering an alternative pathway alongside emergency surgery.

Sep 22, 2026

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