Management and Outcomes of Bowel Obstruction in Patients with Stage IV Colon Cancer

Abstract

BACKGROUND Bowel obstruction is a common complication of late-stage abdominal cancer, especially colon cancer, which has been investigated predominantly in small, single-institution studies. OBJECTIVE We used a large, population-based data set to explore the surgical treatment of bowel obstruction and its outcomes after hospitalization for obstruction among patients with stage IV colon cancer. DESIGN This was a retrospective cohort study. SETTING AND PATIENTS We identified 1004 patients aged 65 years or older in the Surveillance, Epidemiology and End Results-Medicare database diagnosed with stage IV colon cancer January 1, 1991 to December 31, 2005, who were later hospitalized for bowel obstruction. MAIN OUTCOME MEASURES We describe outcomes after hospitalization and analyzed the associations between surgical treatment of obstruction and outcomes. RESULTS Hospitalization for bowel obstruction occurred a median of 7.4 months after colon cancer diagnosis, and median survival after obstruction was approximately 2.5 months. Median hospitalization for obstruction was about 1 week and in-hospital mortality was 12.7%. Between discharge and death, 25% of patients were readmitted to the hospital at least once for obstruction, and, on average, patients lived 5 days out of the hospital for every day in the hospital between obstruction diagnosis and death. Survival was 3 times longer in those whose obstruction claims suggested an adhesive obstruction origin. In multivariable models, surgical compared with nonsurgical management was not associated with prolonged survival (p = 0.134). LIMITATIONS Use of an administrative database did not allow determination of quality of life or relief of obstruction as an outcome, nor could nonsurgical interventions, eg, endoscopic stenting or octreotide, be assessed. CONCLUSIONS In this population-based study of patients with stage IV colon cancer who had bowel obstruction, overall survival following obstruction was poor irrespective of treatment. Universally poor outcomes suggest that a diagnosis of obstruction in the setting of advanced colon cancer should be considered a preterminal event.

Bowel obstruction in elderly ovarian cancer patients: A population-based study

“…This survival benefit was coupled with more post-obstruction time spent in the hospital, such that percent of life after obstruction spent in the hospital was equivalent between surgical and non-surgical groups, consistent with a trend we previously observed examining obstruction outcomes in the context of stage 4 colon cancer[37]. In that study, as in this, surgery’s survival benefit was no longer significant after adjusting for adhesive etiology, consistent with suggestions that the apparent benefits of surgery may be due to factors leading to selection for surgery[6, 11].…”

Palliative surgery in patients with unresectable colorectal liver metastases: a propensity score matching analysis

“…Up to 65% of stage IV CRC patients had symptoms of tumor complications such as intestinal obstruction, perforation, intractable pain, and bleeding [10]. The most common symptom of patients with stage IV CRC is intestinal obstruction with rates of 7% to 29% [20,21] Because of the more advanced status of the patients in our study, we observed a higher incidence (37.2%) of intestinal obstruction. Non-operative methods including endoscopic stenting or laser recanalization have generally been advocated for patients with poor performance status and/or advanced age in order to reduce the morbidity and mortality associated with surgery.…”

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

“…An accompanying report focuses on the treatments during and outcomes after hospitalization for BO. 49 …”