Outcome prognostic factors in inoperable malignant bowel obstruction
Inoperable malignant bowel obstruction (MBO), a severe complication of peritoneal carcinomatosis, has a low desobstruction rate (30–40 %) and end-of-life decision-making is hampered by the lack of known prognostic factors. This study aimed to explore prognostic factors for desobstruction in MBO.
All patients with inoperable MBO admitted in our large oncology hospital between 2010 and 2013 were treated following a clinical protocol based on antiemetics, steroids and two antisecretories, octreotide, and hyoscine butylbromide. Two prognostic factor analyses using logistic regressions were performed, one based on data from day 1 of admission and the other on data from day 8.
Forty-five patients were included. Frequency of desobstruction was 48.9 %. In the analysis of prognostic factors on day 1, MBO episodes derived from functional physiopathologic mechanisms (vs. mechanic or mixed) were more prone to resolve (p < 0.001 corrected for multiple comparisons). Considering patients alive with persistent obstruction on day 8, a better clinical condition was the variable more associated with desobstruction, but without statistical significance after correction for multiple comparisons.
A functional physiopathologic mechanism of MBO development may be an early prognostic factor for desobstruction. A high proportion of desobstruction was observed, suggesting that the combination of antisecretories with different mechanism of action warrants further investigation.
KeywordsMalignant bowel obstruction Octreotide Hyoscine butylbromide Prognostic factors
Compliance with ethical standards
All procedures were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
Conflict of interest
The authors declare no conflicts of interest. No funding was required for this work.
- 3.Feuer DJ, Broadley K. (2004) Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. In: The Cochrane Library. Wiley, ChichesterGoogle Scholar
- 5.Fallon MT (1994) The physiology of somatostatin and its synthetic analogue, octreotide. Eur J Palliat Care 1:20–22Google Scholar
- 8.Ripamonti C, Mercadante S, Groff L, Zecca E, De Conno F, Casuccio A (2000) Role of octreotide, scopolamine butylbromide, and hydration in symptom control of patients with inoperable bowel obstruction and nasogastric tubes: a prospective randomized trial. J Pain Symptom Manag 19:23–34CrossRefGoogle Scholar
- 9.Mystakidou K, Tsilika E, Kalaidopoulou O, Chondros K, Georgaki S, Papadimitriou L (2002) Comparison of octreotide administration vs. conservative treatment in the management of inoperable bowel obstruction in patients with far advanced cancer: a randomized, double- blind, controlled clinical trial. Anticancer Res 22:1187–1192PubMedGoogle Scholar
- 13.Mariani P, Blumberg J, Landau A, Lebrun-Jezekova D, Botton E, Beatrix O, Mayeur D, Herve R, Maisonobe P, Chauvenet L (2012) Symptomatic treatment with lanreotide microparticles in inoperable bowel obstruction resulting from peritoneal carcinomatosis: a randomized, double-blind, placebo-controlled phase III study. J Clin Oncol 30:4337–4343CrossRefPubMedGoogle Scholar
- 20.Watari H, Hosaka M, Wakui Y, Nomura E, Hareyama H, Tanuma F, Hattori R, Azuma M, Kato H, Takeda N, Ariga S, Sakuragi N (2012) A prospective study on the efficacy of octreotide in the management of malignant bowel obstruction in gynecologic cancer. Int J Gynecol Cancer 22:692–696CrossRefPubMedGoogle Scholar