Malignant Bowel Obstruction: Natural History of a Heterogeneous Patient Population Followed Prospectively Over Two Years

Chakraborty, Anita; Selby, Debbie; Gardiner, Kate; Myers, Jeff; Moravan, Veronika; Wright, Frances C.

doi:10.1016/j.jpainsymman.2010.05.007

Cited by 61 publications

(44 citation statements)

References 17 publications

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“…However, not all patients in this cohort underwent surgery for BO, as other causes for surgical consultation such as gastrointestinal bleeding, and wound infection was included. Considering 30-day surgical morbidity, the overall rate for the current study is 35.6 %, which compares favorably to literature values 5, 10, 16 .…”

Section: Discussionsupporting

confidence: 85%

Management of Bowel Obstruction in Patients with Stage IV Cancer: Predictors of Outcome After Surgery

et al. 2012

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Introduction Patients with Stage IV cancer and bowel obstruction (BO) present a complicated management problem. We sought to determine if specific parameters could predict outcome after surgery. Methods Records of patients with Stage IV cancer and BO treated from 1991–2008 were reviewed. For surgical patients, 30-day morbidity and 90-day mortality were assessed using exact multivariable Logistic regression methods. Results Of 198 patients, 132 (66.7%) underwent surgery, 66 medical treatment alone, and demographics were similar. 41 (20.7%) patients were diagnosed with Stage IV cancer and BO synchronously, all treated surgically; the remaining presented metachronously. Medically managed patients were more likely to have received chemotherapy in the 30 days prior to BO [45/66 (68.2%) vs 40/132 (30.3%), p <0.01]. In the surgical group, 30-day morbidity was 35.6%, while 90-day mortality was 42.3%. Median overall survival for synchronous patients was 14.1 months (95 % CI 7.6, 23.2), and 3.7 months (95 % CI 2.5, 5.2) and 3.6 months (95 % CI 1.5, 5.2) for metachronous patients treated surgically and medically, respectively. A multivariate model for 90-day surgical mortality identified low serum albumin, metachronous presentation, and ECOG > 1 as predictors of death (p<0.05). A model for 30-day surgical morbidity yielded low hematocrit as a predictive factor (p<0.05). Conclusions This cohort identifies characteristics indicative of morbidity and mortality in Stage IV cancer and BO. Low serum albumin, ECOG > 1, and metachronous presentation predicted for 90-day surgical mortality. These data suggest factors that can be used to frame treatment discussion plans with patients.

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Section: Discussionsupporting

confidence: 85%

Management of Bowel Obstruction in Patients with Stage IV Cancer: Predictors of Outcome After Surgery

et al. 2012

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“…Malignant bowel obstruction (MBO) is a common pre-terminal event for patients with advanced cancer, with an incidence as high as 28% in gastrointestinal cancer and 51% in ovarian cancer 1,2 . Patients with MBO are unable to eat, experience severe pain, and develop intractable nausea and vomiting – symptoms that incite considerable distress for patients and their families 3,4 .…”

Section: Introductionmentioning

confidence: 99%

Palliative Surgery for Malignant Bowel Obstruction From Carcinomatosis

et al. 2014

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Importance Care of patients with malignant bowel obstruction caused by peritoneal metastases may present an ethical dilemma for surgeons when nonoperative management fails. Objective To characterize outcomes of palliative surgery for malignant bowel obstruction from peritoneal carcinomatosis to guide decision making about surgery and postoperative interventions for patients with terminal illness. Evidence Review We searched PubMed, EMBASE, Cochrane Library, Web of Knowledge, CINAHL Plus, and Google Scholar, and performed manual searches of selected journals from inception to August 30, 2012 with no filters, limits, or language restrictions. We used database-specific combinations of intestinal obstruction, malignant, surgery or surgical, and palliat*. We included studies reporting outcomes after palliative surgery for malignant bowel obstruction from peritoneal carcinomatosis from any primary malignancy and excluded case studies, curative surgery, isolated percutaneous procedures, stenting for intraluminal lesions, and studies in which benign and malignant obstructions could not be distinguished. We assessed quality with the Newcastle-Ottawa Scale. Findings We screened 2347 unique articles, selected 108 articles for full-text review, and included 17 studies. Surgery was able to palliate obstructive symptoms for 32 to 100% of patients, enable resumption of a diet for 45 to 75% of patients, and facilitate discharge to home in 34–87% of patients. Mortality was high (6–32%), and serious complications are common (7–44%). Frequent re-obstructions (6–47%), readmissions (38–74%), and re-operations (2–15%) occur. Survival was limited (median 26–237 days), and hospitalization for surgery consumed a substantial portion of the patient’s remaining life (11–61%). Conclusions and Relevance Although palliative surgery can benefit patients, it comes at the cost of high mortality and substantial hospitalization relative to the patient’s remaining survival time. Preoperatively, surgeons should present realistic goals and limitations of surgery. For patients choosing surgery, clarifying preferences for aggressive postoperative interventions preoperatively is critical given the high complication rate and limited survival after surgery for malignant bowel obstruction.

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“…Malignant bowel obstruction is a common event in patients with locally advanced cancers, reaching an incidence of 28 % in GI cancer and 51 % in OC [1,2]. Symptoms are related to the level of obstruction and usually include severe abdominal pain and distension, nausea, vomiting, and inability to pass gas and stool [52].…”

Section: Palliative Surgery and Managing Bowel Obstruction In Peritonmentioning

confidence: 99%

“…However, many patients with advanced disease have no indications to be treated either by this procedure or by any other systemic therapy. Chronic pain, development of malignant ascites (MA), and bowel obstruction are often reported by the majority of those patients, with detrimental physiological and psychological status affecting quality of life (QoL) and leading to very poor prognosis [1][2][3][4][5][6]. Even if still controversial, CRS plus HIPEC may play an important role in palliative treatment, especially when associated with a less invasive approach to obtain the best results with limited morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Palliative Treatments

Sibio¹,

Atta²,

Biacchi³

et al. 2015

Treatment of Peritoneal Surface Malignancies

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Malignant Bowel Obstruction: Natural History of a Heterogeneous Patient Population Followed Prospectively Over Two Years

Abstract: Interventions such as chemotherapy and TPN may be appropriate in a carefully selected subgroup of patients. A collaborative approach is required for the optimal clinical management and palliation of MBO.

Cited by 61 publications

References 17 publications

Management of Bowel Obstruction in Patients with Stage IV Cancer: Predictors of Outcome After Surgery

Management of Bowel Obstruction in Patients with Stage IV Cancer: Predictors of Outcome After Surgery

Palliative Surgery for Malignant Bowel Obstruction From Carcinomatosis

Palliative Treatments

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