Moyana TN. Emergency surgery for malignant large bowel obstruction: Assessing management options and outcomes. World J Gastrointest Surg 2026; 18(2): 113867 [DOI: 10.4240/wjgs.v18.i2.113867]
Corresponding Author of This Article
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. tmoyana@toh.ca
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Surgery
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Editorial
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Feb 27, 2026 (publication date) through Feb 26, 2026
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Publication Name
World Journal of Gastrointestinal Surgery
ISSN
1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Moyana TN. Emergency surgery for malignant large bowel obstruction: Assessing management options and outcomes. World J Gastrointest Surg 2026; 18(2): 113867 [DOI: 10.4240/wjgs.v18.i2.113867]
World J Gastrointest Surg. Feb 27, 2026; 18(2): 113867 Published online Feb 27, 2026. doi: 10.4240/wjgs.v18.i2.113867
Emergency surgery for malignant large bowel obstruction: Assessing management options and outcomes
Terence N Moyana
Terence N Moyana, Division of Diagnostic and Molecular Pathology, The Ottawa Hospital and University of Ottawa, Ottawa K1H 8L6, Ontario, Canada
Author contributions: Moyana TN is responsible for all aspects of the work, including the conception, design, research, writing, and finalization of the manuscript.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
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. tmoyana@toh.ca
Received: September 5, 2025 Revised: November 11, 2025 Accepted: December 3, 2025 Published online: February 27, 2026 Processing time: 174 Days and 14.1 Hours
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 one-size-fits-all approach. It is also noteworthy that the increasing acceptance of self-expanding 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.
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 cancer diagnostics and the monitoring of minimal residual disease, promising improved outcomes in the future.
