The evolution of surgery for the treatment of malignant large bowel obstruction

Large bowel obstruction (LBO) secondary to malignancy is an urgent or emergent surgical condition. Despite recent advances in alternative therapies, surgery remains the primary evidence-based curative, palliative, or temporizing treatment option. Acute presentations of malignant LBO are likely to be associated with advanced age, multiple comorbidities, advanced disease stage, and a poor prognosis. Immediate management should focus on prompt diagnosis, resuscitation, and treatment to relieve the obstruction. The modern operating room should be thought of as the arena where the highest probability for optimal outcomes is achieved. This article outlines the evolving role of malignant LBO surgery, and how newer approaches to operative treatment may improve clinical outcomes.