During this episode of SurgOnc Today, Jan Franko, MD, PhD, Niraj J. Gusani, MD, MS, and Viet H. Le, MD, discuss malignant bowel obstruction (MBO). They define MBO broadly as any symptoms compatible with bowel obstruction in settings of rather large volume intraabdominal malignancy. Some 30% GI cancers, and some 50% ovarian cancers develop MBO – often a preterminal event. For clarity, they did not consider clinically more straightforward situations of malignant single-point obstructions treatable by resection, bypass or stent. They will forego localized gastric outlet, duodenal and rectosigmoid primary tumors. They explore what symptom burden could be potentially qualify as obstructive symptoms: frank MBO with total dependency on gastric decompression, or perhaps symptoms of progressive weight loss without over need for gastric decompression or parenteral nutrition. Over past 20 years median overall survival those diagnosed with MBO is 3-4 months. If operated, perioperative 30-day mortality is commonly 6-15%, and perhaps as high as 40% among those with ascites. These outcomes are drive by difficult-to-treat disease and palliative nature of therapy. Depressing outcomes are difficult to explain to patients, families, and administrators. Care for those suffering. Treatment options include non-operative (gastric decompression, antiemetics, somatostatin analogies, TPN/IVF support, and hospice care), non-operative interventional (GI stenting), and operative (resections, bypass, stoma, functional palliative cytoreduction, ascites control). They discuss expectations from accrued SWOG S1316 trial: Prospective Comparative Effectiveness Trial for Malignant Bowel Obstruction.