Prognostic Factors for Surgical Failure in Malignant Bowel Obstruction and Peritoneal Carcinomatosis

Abstract

Introduction: Patients with peritoneal metastasis frequently develop malignant bowel obstruction (MBO). Medical palliative management is preferred but often fails. Conversely, the role of palliative surgery remains unclear and debated. This study aims to identify patients who could benefit from invasive surgical interventions and factors associated with successful surgical palliation.Materials and Methods: In this retrospective study, 98 consecutive patients who underwent palliative surgery for MBO over 5 years were reviewed. We evaluate as the primary outcome surgical failure to select patients who could benefit from palliative surgery, avoiding unnecessary surgery. A prognostic score was developed based on a logistic regression model to identify patients at risk of surgical failure. The score was evaluated for overall accuracy by receiver operating characteristic curve analysis.Results: Palliative surgery was achieved in 76 (77.5%) patients. The variables that were found to be significant factors for surgical failure are recurrent disease (P = 0.015), absence of bowel obstruction (P < 0.001), absence of bowel distension (P < 0.001), and mesenteric involvement (P = 0.001) and retraction (P < 0.001). The absence of bowel distension (P = 0.046) and bowel obstruction (P = 0.012) emerged as independent predictors of surgical failure. Carcinomatosis level assessment for peritoneum score, based on these factors, was built to evaluate the risk of surgical failure.Conclusion: Our proposed scoring system might help select patients most likely to benefit from palliative surgery.

Readmission and Disposition in Patients With Malignant Bowel Obstructions Following Gastrostomy Tube

“…[2][3][4] MBO from PC is managed in a multidisciplinary setting and may involve palliative considerations, given it often reflects disease progression and the advanced nature of a patient's metastatic disease. 5 Surgical interventions such as palliative diverting ostomy, bowel resection, and bypass are invasive treatment options and are only appropriate in a subset of patients given the high associated morbidity and mortality. 5,6 Other management options include medical treatments such as corticosteroids, antiemetics, and antisecretory medications.…”

Spiliotis-Farfarelos Maneuver for the Management of Small Bowel Obstruction and Frozen Pelvis in Patients With Peritoneal Metastasis

“…On the contrary, infiltration of the root of the small bowel mesentery and extensive small bowel disease that could leave short bowel syndrome after resection are potential contraindications for primary cytoreduction [ 3 ]. Furthermore, bowel obstruction complicates a significant proportion of patients with peritoneal carcinomatosis (PC), while as high as 50% of them presented with the recurrent disease even after complete cytoreduction [ 4 ]. Bowel obstruction can be due to either infiltration of the bowel and mesentery by the primary tumor or secondary due to the compression of the bowel from the primary lesion [ 4 ].…”

“…Furthermore, bowel obstruction complicates a significant proportion of patients with peritoneal carcinomatosis (PC), while as high as 50% of them presented with the recurrent disease even after complete cytoreduction [ 4 ]. Bowel obstruction can be due to either infiltration of the bowel and mesentery by the primary tumor or secondary due to the compression of the bowel from the primary lesion [ 4 ]. Obstruction can also be caused by the presence of cancer adhesions and carries a grim outlook.…”

“…In cases of PC with intestinal involvement, most of them include multiple metastatic sites mostly identified in the small bowel and are located in the pelvic part of the bowel and more specifically in the terminal ileum as well as the right colon. The surgical approach has been applied either for palliative purposes to reduce symptomatology or with curative intention in cases of malignancies where complete resection of the recurrent disease has been proved to improve survival [ 4 ]. Furthermore, the concomitant application of hyperthermic intraperitoneal chemotherapy (HIPEC) can offer a favorable therapeutic outcome in selected cases.…”

Inoperable Bowel Obstruction in Ovarian Cancer: Prevalence, Impact and Management Challenges

“…Several studies showed that presence of poor performance status, pain, exertional shortness of breath, cognitive impairment, ascites, palpable masses in abdomen and pelvis, poor nutritional status, low albumin, liver failure, multifocal obstruction, and proximal MBO correlated with dismal survival. [16][17][18][19][20][21][22][23] Moreover, a recent retrospective review identified CT findings of ascites, mesenteric disease, and dilated bowel loop wall thinning as poor prognostic indicators. 24 Retrospective analyses have shown that systemic chemotherapy after the development of MBO is associated with superior survival, irrespective of whether patients were treated medically or surgically for MBO.…”