Surgical management for a malignant bowel obstruction with recurrent gastrointestinal carcinoma

Abstract

Palliative operations for the patients with manifest ascites of MBO are risky and rarely effectively improve oral intake, but this is not considered to be a contraindication for surgical management. Informed consent is therefore important in the surgical management of MBO.

A scoring system for the prognosis and treatment of malignant bowel obstruction

“…Factors such as the presence of ascites and carcinomatosis conveyed a poor prognosis—a finding consistent with previos publications. 22-24 Albumin was shown in our study and by others to be a predictor of survival. 25 Leukocytosis was shown to be a marker of both short-term and overall survival.…”

“…Other researchers have also shown that the presence of ascites and/or carcinomatosis reduce the likelihood of return to oral in-take. 22 The difficulty with using this outcome in therapy in a retrospective review is the inability to clearly define successful return to oral intake. Given the subjective nature of “tolerating oral intake,” we focused on a more concrete endpoint of mortality on which to base our nomogram.…”

“…Several factors have been found to improve outcomes from surgical intervention for MBO and include the absence of ascites, 22-24 a good performance status, 25 low blood urea nitrogen, 25 a high albumin level, 25 absences of carcinomatosis, 23 and only 1 obstructive point along the alimentary tract. 23 These factors have been determined from several small studies that only examined patients who were treated with surgical therapy because randomized, controlled trials in this patient population are almost impossible to conduct.…”

Consensus Guideline for the Management of Malignant Gastrointestinal Obstruction in Patients with Peritoneal Surface Malignancies

“…3,14,19,51 Various studies in our review identified ascites as a negative prognostic factor for oral intake and survival after operative and non-operative interventions. 3,4,14,17,40,52 Technical challenges in percutaneous endoscopic gastrostomy (PEG) tube placement can be anticipated in the presence of ascites and diffuse peritoneal metastases involving the greater omentum and gastric serosa. 53,54…”

“…Factors known to be associated with diminished surgical benefit include high peritoneal disease burden, multifocal obstruction, ascites, multiple metastatic sites, high-grade histology, poor performance status, and indicators of poor nutrition, such as low serum albumin. 3,4,12,14,33,35,40,41,44,52,68,69 Small bowel obstruction is associated with a poor prognosis, as highlighted in Lodoli et al's study including 98 patients with peritoneal carcinomatosis. Amongst these patients, definitive surgery was not possible in 22% of cases, indicative of technical failure.…”