Surgical management of malignant bowel obstruction: Strategies toward palliation of patients with advanced cancer

Debernardo, Robert

doi:10.1007/s11912-009-0040-4

Cited by 18 publications

(16 citation statements)

References 34 publications

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“…2,20,25 Retrospective series have also reported inhospital mortality rates of between 5% and 38% in patients treated operatively and nonoperatively for BO, 26,27 similar to our 12.7% in-hospital mortality and indicative of the nutrition depletion and debilitated functional status common in this population. 8 …”

Section: Discussionmentioning

confidence: 99%

“…39 For similar reasons, we were unable to assess the use of octreotide. 8–11 Further, we could not determine the indication for the use of gastrostomy tubes (ie, decompression vs feeding), nor could we assess the effectiveness of nasogastric suctioning. Most importantly, we were unable to assess the indications for surgery and, therefore, could not adjust treatment analysis for patient selection.…”

Section: Discussionmentioning

confidence: 99%

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

Winner

Mooney

Hershman³

et al. 2013

Diseases of the Colon &Amp; Rectum

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Winner

Mooney

Hershman³

et al. 2013

Diseases of the Colon &Amp; Rectum

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“…Estimation of CA-125 may be helpful. Diligent discussion with the primary team and frank discussions with the patient and his or her family are essential to formulate an appropriate plan [58].…”

Section: Ovarian Cancer Related Bowel Obstructionmentioning

confidence: 99%

Decision Making in Bowel Obstruction: A Review

Pujahari

2016

JCDR

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IntRoductIonOver the last 100 years, the anatomical location of Bowel Obstruction (BO) has remained unchanged; however, the aetiological factors in small and large BO have changed significantly. With advance of time more and more elderly patients are presenting with BO [1]. But still, BO continues to be one of the most common surgical emergencies [2] encountered in general surgery units and it continues to be a major cause of morbidity and financial expenditure [3]. Peritoneal adhesions and hernia were the most common causes of BO and contributing 42.3% [4]. All patients of BO are potential candidates for major abdominal surgery with long term morbidity and possible mortality. Hence, the decision of surgery and its timing is vital.Various factors are considered for taking the decision on operative or non-operative management. The factors considered are age of the patients, duration of obstruction, volume of nasogastric aspirate, findings on the radiological imaging, previous abdominal surgeries and malignancy. decision in Small Bowel obstruction (SBo)Clinical presentation of pain, vomiting, distension and constipation, laboratory and radiographic factors should all be considered when making a decision about treatment of BO [5]. One must rule out an abdominal wall hernia as a cause of BO, which is seen in 26.8% of cases in virgin abdomen [4]. Plain radiograph should be an integral part of management of patients with clinical suspicion of BO and gastrointestinal perforation [6] [Table/ Fig-1]. The diagnosis in most cases will be confirmed by further imaging studies such as ultrasound, contrast studies or most commonly in contemporary practice, the Computed Tomography (CT) [7].The CT scan, besides confirming the diagnosis of BO, it gives information on partial or complete obstruction, it location, it also provides specific type like closed loop type and helps in deciding early surgery. Contrast Enhanced Computed Tomography (CECT) give enough information on ischemic bowel and bowel oedema, which requires emergency surgery and luminal gastrograffin helps in relieving the BO [8,9].Surgeons find coronal images more helpful than axial images for management [10]. The radiographic transition zone alone does not increase the likelihood of surgical intervention or identify patients who will fail non-operative management [11]. The four cardinal features -intra peritoneal free fluid, mesenteric oedema, presence of the "small bowel faeces sign" and history of vomiting -are predictive of requiring immediate emergency operative intervention [5]. decision in large bowel obstructionIn Indian scenario, two common types of Large Bowel Obstructions (LBO) are seen. They are: (a) Acute obstruction due to Sigmoid volvulus (SV); and (b) Sub-acute or chronic obstruction due to cancer of colon. In suspected volvulus, plain X-rays may help with diagnosis but MRI is more reliable. However, flexible endoscopy is always diagnostic as well as therapeutic [12]. Once diagnosed flatus tube, hydrostatic enema or colonoscopic reduction attempt is th...

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“…2,3 Although untreated BO can be fatal, 4 most patients receive treatment because onset is typically progressive rather than acute, 5,6 and symptoms are too severe to be ignored. 7 The prognosis of patients with BO is poor; life expectancy is typically measured in weeks to months, 8,9 in part because the circumstances that typically give rise to BOs herald the end of life.…”

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confidence: 99%

“…Most estimates cite a range of 15% to 29% 2,3,8,10,11 ; these figures derived from small, hospital-based studies 12,13 that variously include rectal and anal cancers with colon cancers, partial with complete obstructions, and benign with malignant obstructions. 6,12,14–19 To our knowledge, no large-scale, population-based study has examined the incidence or risk factors associated with BO in patients with cancer.…”

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confidence: 99%

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

et al. 2013

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IMPORTANCE Research has been limited on the incidence, mechanisms, etiology, and treatment of symptoms that require palliation in patients with terminal cancer. Bowel obstruction (BO) is a common complication of advanced abdominal cancer, including colon cancer, for which small, single-institution studies have suggested an incidence rate of 15% to 29%. Large population-based studies examining the incidence or risk factors associated with BO in cancer are lacking. OBJECTIVE To investigate the incidence and risk factors associated with BO in patients with stage IV colon cancer. DESIGN AND SETTING Retrospective cohort, population-based study of patients in the Surveillance, Epidemiology, and End Results and Medicare claims linked databases who were diagnosed as having stage IV colon cancer from January 1, 1991, through December 31, 2005. PATIENTS Patients 65 years or older with stage IV colon cancer (n = 12 553). MAIN OUTCOMES AND MEASURES Time to BO, defined by inpatient hospitalization for BO. We used Cox proportional hazards regression models to determine associations between BO and patient, prior treatment, and tumor features. RESULTS We identified 1004 patients with stage IV colon cancer subsequently hospitalized with BO (8.0%). In multivariable analysis, proximal tumor site (hazard ratio, 1.22 [95% CI, 1.07–1.40]), high tumor grade (1.34 [1.16–1.55]), mucinous histological type (1.27 [1.08–1.50]), and nodal stage N2 (1.52 [1.26–1.84]) were associated with increased risk of BO, as was the presence of obstruction at cancer diagnosis (1.75 [1.47–2.04]). A more recent diagnosis was associated with decreased risk of subsequent obstruction (hazard ratio, 0.84 [95% CI, 0.72–0.98]). CONCLUSIONS AND RELEVANCE In this large population of patients with stage IV colon cancer, BO after diagnosis was less common (8.0%) than previously reported. Risk was associated with site and histological type of the primary tumor. Future studies will explore management and outcomes in this serious, common complication.

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Surgical management of malignant bowel obstruction: Strategies toward palliation of patients with advanced cancer

Cited by 18 publications

References 34 publications

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

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

Decision Making in Bowel Obstruction: A Review

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

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