Nutritional care pathways in cancer patients with malignant bowel obstruction: A retrospective multi-centre study

Patel, Pinal S.; Fragkos, Konstantinos; Keane, Niamh; Wilkinson, David; Johnson, Amy; Chan, Derek; Roberts, Bradley; Neild, Penny; Yalcin, Metin; Allan, Philip; FitzPatrick, Michael E.B.; Gomez, Michael; Williams, Sarah; Kok, Klaartje; Sharkey, Lisa; Swift, Carla; Mehta, Shameer; Naghibi, Mani; Mountford, Christopher; Forbes, Alastair; Rahman, Farooq; Di Caro, Simona

doi:10.1016/j.clnesp.2023.11.018

Clinical Nutrition ESPEN

2024

DOI: 10.1016/j.clnesp.2023.11.018

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Nutritional care pathways in cancer patients with malignant bowel obstruction: A retrospective multi-centre study

Pinal S. Patel,

Konstantinos Fragkos,

Niamh Keane

et al.

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2024

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Outcomes of patients admitted with malignant small bowel obstruction: a subgroup multicentre observational cohort analysis

Hupfeld,

Burcharth,

Jensen

et al. 2024

Langenbecks Arch Surg

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Introduction and purpose of the study Small bowel obstruction (SBO) accounts for a substantial proportion of emergency surgical admissions. Malignancy is a common cause of obstruction, either due to a primary tumour or intra-abdominal metastases. However, little is known regarding the current treatment or outcomes of patients with malignant SBO. This study aimed to characterise the treatment of malignant SBO and identify areas for potential improvement and compare overall survival of patients with malignant SBO to patients with non-malignant SBO. Materials and methods This was a subgroup analysis of a multicentre observational study of patients admitted with SBO. Details regarding these patients’ diagnoses, treatments, and outcomes up to 1-year after admission were recorded. The primary outcome was overall survival in patients with malignant SBO. Results A total of 316 patients with small bowel obstruction were included, of whom 33 (10.4%) had malignant SBO. Out of the 33 patients with malignant SBO, 20 patients (60.6%) were treated with palliative intent although only 7 patients were seen by a palliative team during admission. Nutritional assessments were performed on 12 patients, and 11 of these patients received parenteral nutrition. 23 patients underwent surgery, with the most common surgical interventions being loop ileostomies (9 patients) and gastrointestinal bypasses (9 patients). 4 patients underwent right hemicolectomies, with a primary anastomosis formed and 1 patient had a right hemicolectomy with a terminal ileostomy. Median survival was 114 days, and no difference was seen in survival between patients treated with or without palliative intent. Conclusion Malignant SBO is associated with significant risks of short-term complications and a poor prognosis. Consideration should be given to the early involvement of senior decision-makers upon patient admission is essential for optimal management and setting expectation for a realistic outcome.

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Outcomes of patients admitted with malignant small bowel obstruction: a subgroup multicentre observational cohort analysis

Hupfeld,

Burcharth,

Jensen

et al. 2024

Langenbecks Arch Surg

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Management of Malignant Bowel Obstruction in Patients with Gynaecological Cancer: A Systematic Review

Tóth,

Lőczi

et al. 2024

JCM

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Objectives: This systematic review aimed to evaluate current surgical and non-surgical management strategies for malignant bowel obstruction (MBO) in patients with gynaecological cancer. Methods: Comprehensive literature searches were conducted across MEDLINE, Embase, CENTRAL, and Scopus, without restrictions on language or publication date. Following the removal of duplicates, 4866 articles were screened, with 34 meeting the inclusion criteria. Results: Surgical intervention remains the definitive treatment for MBO, offering longer symptom-free periods and improved survival, particularly when conservative methods fail. However, the selection of surgical candidates is crucial due to the high risk of morbidity and the potential for significant complications. Non-surgical treatments, such as the use of Gastrografin, Octreotide, and Dexamethasone, along with invasive procedures like nasogastric tubing, percutaneous gastrostomy, and stent placement, offer varying degrees of symptom relief and are often considered when surgery is not feasible. Conclusions: In this article we provide a potential therapeutic algorithm for the management of patients with MBO. This review underscores the urgent need for high-quality research to develop clear, evidence-based guidelines for MBO management in patients with gynaecologic cancer. Establishing standardised protocols will improve patient outcomes by aiding clinicians in making informed, individualised treatment decisions.

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Nutritional care pathways in cancer patients with malignant bowel obstruction: A retrospective multi-centre study

Cited by 2 publications

References 28 publications

Outcomes of patients admitted with malignant small bowel obstruction: a subgroup multicentre observational cohort analysis

Outcomes of patients admitted with malignant small bowel obstruction: a subgroup multicentre observational cohort analysis

Management of Malignant Bowel Obstruction in Patients with Gynaecological Cancer: A Systematic Review

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