Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution

Abstract

Malignant bowel obstruction (MBO) is a frequent complication in advanced cancer patients, especially in those with abdominal tumors. Clinical management of MBO requires a specific and individualized approach that is based on disease prognosis and the objectives of care. The global prevalence of MBO is estimated to be 3% to 15% of cancer patients. Surgery should always be considered for patients in the initial stages of the disease with a preserved general status and a single level of occlusion. Less invasive approaches such as duodenal or colonic stenting should be considered when surgery is contraindicated in obstructions at the single level. The priority of care for inoperable and consolidated MBO is to control symptoms and promote the maximum level of comfort possible. The spontaneous resolution of an inoperable obstructive process is observed in more than one third of patients. The mean survival is of no longer than 4–5 weeks in patients with consolidated MBO. Polymodal medical treatment based on a combination of glucocorticoids, strong opioids, antiemetics, and antisecretory drugs achieves very high symptomatic control. This review focuses on the epidemiological aspects, diagnosis, surgical criteria, medical management, and factors influencing the spontaneous resolution of MBO in advanced cancer patients.

Outcome of decompression using a transnasal ileus tube in malignant adhesive bowel obstruction: A retrospective study

“…As a result of a poor nutritional status and the multilevel obstructions found in malignant adhesive obstructive bowel patients, treatment is more complicated. Only 30-48.9% of the patients have been successfully treated, as mentioned in the literature (17)(18)(19).…”

“…The combination of analgesics, antisecretors, antiemetics and glucocorticoids is the preferred treatment according to the guidelines of the National Comprehesive Cancer Network (18). These drugs may reduce water retention in the intestinal lumen, as well as splanchnic blood flow, indirectly decreasing intestinal wall edema and peristalsis.…”

“…These drugs may reduce water retention in the intestinal lumen, as well as splanchnic blood flow, indirectly decreasing intestinal wall edema and peristalsis. Over 30% of patients may be treated successfully with drugs (18,20). In our results, the successful intubation resolution rate of patients with malignant bowel obstruction was 42.9%, and there were no intubation-related complications during the therapy.…”

Clinical Impact of Palliative Treatment Using Octreotide for Inoperable Malignant Bowel Obstruction Caused by Advanced Urological Cancer

“…MBO frequencies ranging from 20% to 50% in ovarian cancer and from 10% to 29% in colorectal cancer have been reported (Tuca et al, 2012). MBO has been reported to occur because of obstruction caused by tumor, edema, and fibrosis induced by cancerous peritonitis.…”

A Case Report of Elective Surgery after Intestinal Stent Implantation in Left Colorectal Cancer

“…Left-sided colon cancer often presents with acute intestinal obstruction as the first symptom and requires emergency surgery [1]. Surgery most commonly involves two stages: (1) removing the tumor and making the abdominal wall fistula; (2) closing the fistula 3-6 month late [2].…”