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

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 <i>et al</i> 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 (<i>e.g.,</i> 30, 60, and 90 days as well as 1, 2, and 5 years or longer). Moreover, the heterogeneity of colorectal cancer (<i>e.g.,</i> right-sided <i>vs</i> left-sided cancers <i>vs</i> 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.