Impact of bowel obstruction at the time of initial presentation in women with ovarian cancer

Abstract

Objective To determine whether the presence of bowel obstruction at the time of initial presentation has any prognostic significance in these women.Design Retrospective cohort study.Setting Dedicated gynaecological oncology service of a large tertiary institution.Population Women who had a bowel obstruction as part of their initial presentation of ovarian cancer were identified between 1995 and 2007. Each woman was matched with four control women (with disease but no obstruction).Methods Women with disease were compared with controls to determine the impact, if any, of bowel obstruction at presentation. Several prognostic variables including bowel obstruction were also evaluated in a Cox proportional hazard model. Main outcome measures Progression-free survival (PFS) and overall survival (OS).Results Forty-eight women with disease and 192 controls were identified during the study period. The median follow-up period was 19 months among women with disease versus 20 months in controls. No differences were seen in demographics and clinical characteristics of the women. Optimal cytoreduction rate was similar between the two groups (75% versus 78%, P = 0.7). Patients with bowel obstruction had a shorter PFS and OS compared with controls [19 months versus 21 months (P = 0.01) and 22 versus 35 months (P = 0.008)], respectively. Bowel obstruction at presentation was an independent prognostic variable with a hazard ratio of 1.5 (P = 0.009). Other prognostic variables were age, stage and extent of surgical cytoreduction.Conclusions Bowel obstruction at the time of initial presentation is an adverse prognostic factor in women with ovarian cancer.

Young Patients Presenting With Large Bowel Obstruction Due to Gynecological Malignancy

“…Bowel obstruction in ovarian cancer is unfortunately not an uncommon occurrence. Around 8%-30% of those with ovarian malignancies will have a bowel obstruction at the presentation of their malignancy, 3 with 70% of those being LBOs. Bowel obstruction at the time of diagnosis is known to be associated with worse overall survival.…”

“…Bowel obstruction at the time of diagnosis is known to be associated with worse overall survival. 3 Despite eventual diagnosis and treatment with systemic chemotherapy, both patients with ovarian cancer had progression of their disease. This illustrates the poor prognosis and aggressive nature of ovarian cancer presenting as an LBO.…”

Surgical management of bowel obstruction in gynaecological cancer

“…removing all disease to <1 cm in diameter or no visible residual disease, respectively), because (1) the clinical objective is to treat the obstruction, (2) the women are often unwell and need urgent/emergency surgery, and (3) many of these women are operated on by general surgeons after they presented in accident and emergency departments. Women presenting with bowel obstruction are reported to have shorter progression‐free and overall survivals . The presence of micrometastasis in the bowel mesenteric lymph nodes may be a factor contributing to poorer outcome …”

Bowel obstruction in advanced tubo-ovarian cancer: a retrospective cohort study

“…Malignant bowel obstruction (MBO) is a frequent and distressing complication in advanced and recurrent ovarian cancer, occurring in up to 50% of patients, and often a sign of progressive disease 4 – 9 . In 8–30% of patients, MBO is the presenting symptom of ovarian cancer and may be an indicator of a short progression-free and overall survival 10 , 11 .…”