{
  "abstract": "Background\n\nPeritoneal surface malignancies (PSM) are primary or secondary neoplastic deposits involving the peritoneum and are commonly associated with colorectal, gastric, appendiceal, gynecological, pancreaticobiliary, and other intra-abdominal or extra-abdominal cancers. Malignant bowel obstruction (MBO) is one of the most frequent and clinically consequential emergency presentations in this population, yet diagnostic and therapeutic pathways remain heterogeneous. We aimed to develop evidence-informed recommendations for emergency management of MBO in patients with PSM by integrating a systematic review, meta-analysis and a structured international expert consensus process.Methods\n\nThis systematic review, meta-analysis, and Delphi consensus followed PRISMA, Cochrane, and relevant MOOSE reporting principles. PubMed/MEDLINE and the Cochrane Library were searched from inception to June 2025 (English language). Five predefined PICO/PIRT questions addressed: (1) the diagnostic role of CT, plain abdominal X-ray, or Gastrografin-enhanced X-ray in PSM-related MBO; (2) nonoperative medical management versus surgical or endoscopic therapy; (3) surgical versus endoscopic treatment after failure of nonoperative management; (4) bowel resection versus stoma or bypass in surgical candidates; and (5) endoscopic stenting versus endoscopic ultrasound-guided bypass with lumen-apposing metal stents in endoscopic candidates. Study selection and data extraction were performed independently and in duplicate. Risk of bias was assessed with ROBINS-I for comparative non-randomized studies and MINORS for non-comparative studies; certainty of evidence was rated with GRADE. Random-effects meta-analyses (REML) produced odds ratios (OR), mean differences (MD), pooled means, or pooled proportions with 95% confidence intervals (CI); heterogeneity was summarized using I2, τ2, and 95% prediction intervals. Evidence profiles informed statements voted on by the WSES-PSOGI-SICO expert panel during the 2025 WSES Congress.Results\n\nNo comparative diagnostic study evaluated abdominal X-ray or Gastrografin-enhanced X-ray in PSM-related MBO; two small retrospective CT-based series supported contrast-enhanced CT for mapping obstruction and excluding urgent complications, but no diagnostic meta-analysis was possible. For medical versus procedural treatment, medical management was associated with lower morbidity (OR 0.16, 95% CI 0.07-0.39) and shorter length of stay (MD - 9.48 days, 95% CI - 12.65 to -6.32), while success, mortality, and overall survival remained inconclusive. For surgery versus endoscopy, surgery showed higher clinical success (OR 2.57, 95% CI 1.47-4.50), whereas endoscopy shortened hospital stay (MD 3.35 days, 95% CI 1.46-5.23); mortality did not differ (OR 1.02, 95% CI 0.70-1.49). Among surgical options, resection showed a signal toward higher perioperative mortality than bypass or ostomy (OR 3.55, 95% CI 1.45-8.68). Endoscopic stenting showed a pooled clinical success rate of 0.71 (95% CI 0.62-0.79), whereas evidence on LAMS was limited to one retrospective study. All guideline statements reached 100% agreement among voting participants.Conclusions\n\nDespite the low certainty of available evidence, integration of systematic review findings with expert consensus provides a structured international framework to support decision-making in emergency presentations of PSM-related MBO. These consensus-based recommendations are intended to assist clinicians in harmonizing care across peripheral and referral hospitals, while emphasizing individualized multidisciplinary judgement and the need for future higher-quality evidence.",
  "abstract_shown": true,
  "affiliations": [
    "General Surgery Department, Fondazione IRCCS Policlinico San Matteo, Via Golgi 19, 27100, Pavia, Italy. paola.fugazzola@gmail.com.",
    "Acute Care and Trauma Surgery, ASST GOM Niguarda, Milan, Italy.",
    "Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al‑Ain, United Arab Emirates.",
    "General Surgery Department, ASST Papa Giovanni XXIII, Bergamo, Italy.",
    "Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, San Diego, CA, USA.",
    "Dept of General and Emergency Surgery, Bufalini Hospital AUSL Romagna, Cesena, Italy.",
    "Dept of Medical and Surgical Sciences Alma Mater, Studiorum University of Bologna, Bologna, Italy.",
    "ASST Cremona - UOC General Surgery, Cremona, Italy.",
    "General and Emergency Surgery Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy.",
    "School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.",
    "General Surgery Department, Fondazione IRCCS Policlinico San Matteo, Via Golgi 19, 27100, Pavia, Italy.",
    "Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.",
    "Collegium Medicum, SAN University, Lodz, Poland.",
    "General Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy.",
    "Venice School of Management, Ca' Foscari University of Venice, 30123, Venice, Italy.",
    "Surgical Unit of Peritoneum and Retroperitoneum, Division of General Surgery, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.",
    "4th Department of Surgery, General Hospital \"George Papanikolaou\", Aristotle University of Thessaloniki, 57010, Exochi, Greece.",
    "General Surgery, Istanbul Medeniyet University, Kadikoy, Istanbul, Turkey.",
    "Department of Surgical Science, University of Cagliari, Cagliari, Italy.",
    "Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India.",
    "Surgical Oncology of Digestive Tract, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.",
    "Programma Di Chirurgia Tumori del Peritoneo, UOC Chirurgia d'urgenza Ed Oncologica, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy.",
    "Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, USA.",
    "Department of General Surgery, AUSL Piacenza, Piacenza, Italy.",
    "Digestive Surgery and Liver Transplant Unit, CHU de Nice, Nice, France.",
    "MEDİCANA International Hospital, Istanbul, Turkey.",
    "Department of Surgery, Georgetown University/MedStar Health in Washington DC, Washington, DC, USA.",
    "Program in Peritoneal Surface Malignancy, Washington Cancer Institute, Washington, DC, USA."
  ],
  "article_type": "systematic review",
  "arxiv": null,
  "author_total": 34,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Paola Fugazzola"
    },
    {
      "affs": [
        1
      ],
      "name": "Stefano Granieri"
    },
    {
      "affs": [
        2
      ],
      "name": "Fikri Abu-Zidan"
    },
    {
      "affs": [
        3
      ],
      "name": "Niccolò Allievi"
    },
    {
      "affs": [
        4
      ],
      "name": "Walter L Biffl"
    },
    {
      "affs": [
        5,
        6
      ],
      "name": "Fausto Catena"
    },
    {
      "affs": [
        7
      ],
      "name": "Andrea Celotti"
    },
    {
      "affs": [
        8,
        9
      ],
      "name": "Marco Ceresoli"
    },
    {
      "affs": [
        10,
        11,
        12
      ],
      "name": "Lorenzo Cobianchi"
    },
    {
      "affs": [
        13
      ],
      "name": "Federico Coccolini"
    },
    {
      "affs": [
        10
      ],
      "name": "Andrea Dagnoni"
    },
    {
      "affs": [
        12,
        14
      ],
      "name": "Francesca Dal Mas"
    },
    {
      "affs": [
        15
      ],
      "name": "Andrea Di Giorgio"
    },
    {
      "affs": [
        10
      ],
      "name": "Rebecca Filios"
    },
    {
      "affs": [
        10,
        11
      ],
      "name": "Simone Frassini"
    },
    {
      "affs": [
        10
      ],
      "name": "Ahmed Ghaly"
    },
    {
      "affs": [
        16
      ],
      "name": "Orestis Ioannidis"
    },
    {
      "affs": [
        17
      ],
      "name": "Arda Isik"
    },
    {
      "affs": [
        10
      ],
      "name": "Nikolaos Markou-Pappas"
    },
    {
      "affs": [
        5
      ],
      "name": "Daniele Perrina"
    },
    {
      "affs": [
        3
      ],
      "name": "Michele Pisano"
    },
    {
      "affs": [
        18
      ],
      "name": "Mauro Podda"
    },
    {
      "affs": [
        19
      ],
      "name": "Ramakrishan Seshadri"
    },
    {
      "affs": [
        20
      ],
      "name": "Antonio Sommariva"
    },
    {
      "affs": [
        10
      ],
      "name": "Matteo Tomasoni"
    },
    {
      "affs": [
        21
      ],
      "name": "Marco Vaira"
    },
    {
      "affs": [
        10
      ],
      "name": "Jacopo Viganò"
    },
    {
      "affs": [
        22
      ],
      "name": "Erin Ward"
    },
    {
      "affs": [
        23
      ],
      "name": "Mario Giuffrida"
    },
    {
      "affs": [
        24
      ],
      "name": "Andrea Chierici"
    },
    {
      "affs": [
        25
      ],
      "name": "Cengizhan Yiğitler"
    },
    {
      "affs": [
        26
      ],
      "name": "Steven Wexner"
    },
    {
      "affs": [
        27
      ],
      "name": "Paul Sugarbaker"
    },
    {
      "affs": [
        10,
        11
      ],
      "name": "Luca Ansaloni"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/b2qt1xvkmdf66.bib",
  "cited_by": 0,
  "doi": "10.1186/s13017-026-00718-7",
  "fulltext_url": "https://europepmc.org/articles/PMC13718148",
  "id": "b2qt1xvkmdf66",
  "issns": [
    "1749-7922"
  ],
  "landing_url": "https://europepmc.org/article/MED/42958307",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Review"
    ],
    [
      "openalex",
      "2746|Intraperitoneal and Appendiceal Malignancies"
    ]
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  "openalex": "W7170734461",
  "pdf_url": "https://europepmc.org/articles/PMC13718148?pdf=render",
  "pmcid": "PMC13718148",
  "pmid": "42958307",
  "published": "2026-07-24",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/b2qt1xvkmdf66.ris",
  "sources": [
    {
      "first_seen": "2026-11-01T00:20:48Z",
      "native_id": "MED:42958307",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42958307"
    },
    {
      "first_seen": "2026-11-02T12:22:16Z",
      "native_id": "PMC13718148",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s13017-026-00718-7"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Intraperitoneal and Appendiceal Malignancies",
      "subfield": "surgery"
    }
  ],
  "title": "WSES-PSOGI-SICO evidence-infomed guidelines on surgical emergencies in patients with peritoneal surface malignancies: a systematic review, meta-analysis, and structured expert consensus.",
  "title_text": "WSES-PSOGI-SICO evidence-infomed guidelines on surgical emergencies in patients with peritoneal surface malignancies: a systematic review, meta-analysis, and structured expert consensus.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-02T12:22:16Z",
  "url": "https://research.draconitic.com/paper/b2qt1xvkmdf66",
  "venue": "World journal of emergency surgery : WJES",
  "versions": []
}