Delayed intestinal obstruction following treatment for cancer

Abstract

A review of 117 patients who have been treated for cancer and subsequently developed 173 episodes of intestinal obstruction has established guidelines for the management of the cancer patient with abdominal distress. Operative intervention is the treatment of choice for intestinal obstruction occurring in a patient previously treated for a malignant neoplasm. Approximately one fourth of such patients will have intestinal obstructions which are not caused by recurrence of, or metastases from, the neoplasm for which they had been previously treated. In these patients, obstruction may be due to a new primary cancer or to nonneoplastic disease. The prognosis for such patients is good, with a long‐term survival of 40%. When intestinal obstruction is due to recurrent or metastatic neoplasm, significant palliation may be expected by surgically relieving the intestinal obstruction even when multiple episodes are experienced. The interval of palliation following each subsequent obstruction is, however, of progressively shorter duration. Nonoperative management of these patients has been uniformly unsuccessful. Repeated exploration and bowel resection is indicated for palliation and, on occasion, may be curative even when intestinal obstruction is due to local recurrence of cancer.

Incidence and Predictors of Bowel Obstruction in Elderly Patients With Stage IV Colon Cancer

“…2,3 Although untreated BO can be fatal, 4 most patients receive treatment because onset is typically progressive rather than acute, 5,6 and symptoms are too severe to be ignored. 7 The prognosis of patients with BO is poor; life expectancy is typically measured in weeks to months, 8,9 in part because the circumstances that typically give rise to BOs herald the end of life.…”

Usefulness of CT in patients with intestinal obstruction who have undergone abdominal surgery for malignancy.

“…a resectable or easily bypassed local recurrence. or a potentially curable new primary tumor [5,6]. For this reason, cancer patients who do not have proven recurrent tu mor or peritoneal carcinomatosis are recom mended for aggressive treatment with early surgery in response to the failure of conserva tive management of the obstruction [20,21].…”

“…However, the percentageof benign causes of obstruction ranges from 18% to 38% on the basisof the distribution of the pri mary cancer [2,5,6]. Benign obstruction is more likely if pelvic irradiation was used in the management of the primary tumor [2], whereas the chance of malignant obstruction is increased if the patient had known meta staticcanceror if the primarycanceris in an advanced stage or of gynecologic origin [5,6]. Some of the clinical symptoms and signs, such as a palpable mass or history of hema tochezia.…”

Management of intestinal obstruction in malignant disease

“…2 In the presence of existing malignancy, up to 20% of obstructions can be due to adhesions. 11,12 The decision to operate on a patient with advanced malignancy must take into account indicators of poor prognosis:…”

“…2 In the presence of existing malignancy, up to 20% of obstructions can be due to adhesions. 11,12 The decision to operate on a patient with advanced malignancy must take into account indicators of poor prognosis:poor general condition previous surgical findings of advanced intra-abdominal disease other indicators of advanced disease, such as ascites or distant metastases previous radiotherapy to the abdomen or pelvis, or combination chemotherapy small bowel obstruction (higher mortality and morbidity than large bowel obstruction). 3 The options must be discussed with patient and, if the patient agrees, with the partner and family.…”