Outcomes following percutaneous upper gastrointestinal decompressive tube placement for malignant bowel obstruction in ovarian cancer

Abstract

Objective The objective of this study was to evaluate peri-operative and survival outcomes of ovarian cancer patients undergoing percutaneous upper gastrointestinal decompression for malignant bowel obstruction (MBO). Methods Retrospective chart review was used to identify patients with ovarian, peritoneal, or fallopian tube cancer who underwent palliative decompressive treatment for MBO from 1/2002–12/2010. Kaplan-Meier methods were used to estimate the median survival (MS) and multivariate analysis used to determine if any variables were associated with the hazard of death. Results Fifty-three patients met inclusion criteria. Median length of diagnosis prior to intervention was 21 months. Fifteen (28.3%) patients experienced complications and 9 required revision. Forty-nine (92.5%) experienced relief of symptoms after placement, and 91% tolerated some form of oral intake. Following placement, 19 (36%) patients received additional chemotherapy and 21(41%) patients received total parental nutrition (TPN). Thirty-five patients were discharged home/outpatient facility, 16 to hospice care, and 2 died prior to discharge. MS for all patients was 46 days. Patients who received chemotherapy had a MS of 169 days compared to 33 days (p<0.001). We failed to find an association between survival and TPN or performance status. Conclusions Malignant bowel obstruction is a common complication of ovarian cancer. Management is palliative; risks and benefits of any therapy must be considered. Percutaneous decompressive therapy provides relief from associated symptoms, and allows patients to be discharged home. Median survival in this group is limited, and decisions regarding aggressive therapy should be individualized.

Benefits and risks of a percutaneous endoscopic gastrostomy (PEG) for decompression in patients with malignant gastrointestinal obstruction

“…The overall complication rate of 75% in our study was higher than the rates described in previous studies (11-38%) [7][8][9][10][11]20]. In particular, the percentage of reported minor complications (69%) exceeded those of other studies (9-33%) [7][8][9][10][11][12][13]20].…”

“…In particular, the percentage of reported minor complications (69%) exceeded those of other studies (9-33%) [7][8][9][10][11][12][13]20]. This difference may be due to the practice of assessing complications in our study by using nursing reports to detect complications, such as mild wound pain or minor stomal leakage.…”

“…These complications may not have been pronounced enough to be mentioned in the final medical report and thus not assessed in previous research. Moreover, the rate of major complications (24%) was higher than those described in the literature (0-11%) [7][8][9][10][11]20]. The failure of the first attempt of the PEG insertion was the most common major complication in our study population.…”

“…PEG percutaneous endoscopic gastrostomy Tube occlusion seems to be a common phenomenon [7,8,10,12]. In most patients, routine flushing, changes of position and adequate oral intake of fluids led to improved drainage.…”

“…Previous studies on percutaneous gastrostomies in patients with MBO focus on technical success rates, safety, general outcome and survival [7][8][9][10][11][12][13][14][15][16]. The associated alleviation of symptoms has often been stated, but has not yet been investigated in detail [7][8][9][10][11][12][13]. More detailed data on the quality of venting gastrostomies would considerably assist physicians and patients in balancing personal goals, benefits and potential risks in the terminal stage of disease.…”