Malignant bowel obstruction: a comparison among pre-operative factors, surgical approaches, and survival. Is surgery worthwhile?
DOI:
https://doi.org/10.18203/2349-2902.isj20230955Keywords:
Malignant bowel obstruction, Cancer, Palliative care, Medical managementAbstract
Background: Malignant bowel obstruction (MBO) is defined as the evidence of obstruction distally to the Treitz ligament in the presence of a malignant peritoneally disseminated neoplasm. Patients with this condition suffer from decreased quality of life due to impaired food intake, recurrent nausea, and abdominal pain. The objective was to investigate the outcome of patients with MBO surgically treated, considering post-treatment survival, surgical morbidity, and length of hospital stay, in order to assess the efficiency and impact of surgery at this advanced stage of disease.
Methods: We reviewed retrospectively data collected from 198 patients diagnosed with MBO at Instituto do Câncer do Estado de São Paulo (ICESP), operated between 2018 and 2021.
Results: Among preoperative factors, advanced stages and poor clinical status were associated with earlier death (stage IV had 4.53 higher chance of death). On the other hand, patients considered candidates for invasive life support measures had longer postoperative survival (non-candidates had a chance 1,000,000 times higher of death). Primary diagnosis also showed to be an important risk factor: ovary malignancies had higher risk of surgical complications (OR of 14.28), when compared to gastric and colon cancers. Considering intraoperative factors, patients who underwent resections had better long-term survival (9.9 months) than those who underwent bypass (1.3 months) or stomas (2 months); p=0.017. Finally, considering post-operative factors, long-term survival was associated with shorter hospital stay (p=0.001).
Conclusions: Medical and surgical treatment should be employed on a case-by-case basis, after taking into consideration multiple pre-operative factors, such as KPS and primary tumor stage.
Metrics
References
Olson TJP, Pinkerton C, Brasel KJ, Schwarze ML. Palliative surgery for malignant bowel obstruction from carcinomatosis: a systematic review. JAMA Surg. 2014;149(4)383-92.
Feuer DJ, Broadley KE, Shepherd JH, Barton DP. Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev. 2000;3(4):002764.
Chakraborty A, Selby D, Gardiner K, Myers J, Moravan V, Wright F. Malignant bowel obstruction: natural history of a heterogeneous patient population followed prospectively over two years. J Pain Symptom Manage. 2011;41(2);412-20.
Sousa JHB, Bianchi ET, Tustumi F, Leonardi PC, Junior UR, Ceconello I. Surgical management of malignant intestinal obstruction: outcome and prognostic factors. Chirurgia. 2019;114(3):343-51.
Borneman T, Chu DZJ, Wagman L. Concerns of family caregivers of patients with cancer facing palliative surgery for advanced malignancies. Onc Nurs Forum. 2003;30(6):997-1005.
Ripamonti CI, Easson AM, Gerdes H. Management of malignant bowel obstruction. Eur J Cancer (Oxford, England). 2008;44:1105-15.
Heyler L, Easson AM. Surgical approaches to malignant bowel obstruction. J Support Oncol. 2008;6(3):105-13.
Micco M, Sbarra M, Gui B, Bianco NC, Rodolfino E, Manfredi R. Prognostic CT findings of malignant bowel obstruction in patients with advanced ovarian cancer. Tumori J. 2020;106(2):149-54.
Ripamonti C. Management of bowel obstruction in advanced cancer. Curr Opin Oncol. 1994;6:351-7.
Mooney SJ, Winner M, Hershman DL. Bowel obstruction in elderly ovarian cancer patients: a population-based study. Gynecol Oncol. 2013;129:107-12.
Madar BS, Jayakrishnan TT, Goblin TC, Turaga KK. Surgical management of bowel obstruction in patients with peritoneal carcinomatosis. J Surg Oncol. 2014; 110:666-9.
Kolomainen DF, Daponte A, Barton DP, Pennert K, Ind TE, Bridges JE, et al. Outcomes of surgical management bowel obstruction in relapsed epithelial ovarian cancer (EOC). Gynecol Oncol. 2012;125(1):31-6.
McCarthy JD. A Strategy for intestinal obstruction of peritoneal carcinomatosis. Arch Surg. 1986;121(9):1081-2.
Caitlin TY, Merchant S. Considerations in the management of malignant bowel obstruction. Surg Oncol Clin N Am. 2021:461-74.
McCahill LE, Krouse RS, Chu DZ. Decision making in palliative surgery. J Am Coll Surg. 2002;195(3):411-22.
Merchant SJ, Brogly SB, Booth CM. Management of cancer-associated intestinal obstruction in the final year of life. J Palliat Care. 2020;35(2):84-92.
Lilley EJ, Scott JW, Goldberg JE. Survival, healthcare utilization, and end-oflife care among older adults with malignancy-associated bowel obstruction: comparative study of surgery, venting gastrostomy, or medical management. Ann Surg. 2018;267(4):692-9.
Sugarbaker P. Peritoneal surface oncology: review of a personal experience with colorectal and appendiceal malignancy. Tech Coloproctol. 2005;9(2):95-103.
Lee SY, Jung MR, Kim CH. Nutritional risk screening score is an independent predictive factor of anastomotic leakage after rectal cancer surgery. Eur J Clin Nutr. 2018;72(4):489-95.
Ripamonti CI, Twycross R, Baines M, Bozzetti F, Capri S, DeConno F, et al. Clinical practice recommendations for the management of bowel obstruction in patients with end-stage cancer. Support Care Cancer. 2001;9(4):223-33.
