Supportive Care in Cancer

, Volume 24, Issue 11, pp 4577–4586 | Cite as

Outcome prognostic factors in inoperable malignant bowel obstruction

  • Margarita RomeoEmail author
  • Maria de los LLanos Gil
  • José Luís Cuadra Urteaga
  • Laia Vilà
  • Sara Ahlal
  • Alberto Indacochea
  • Núria Pardo
  • Joaquim Radua
  • Albert Font
  • Albert Tuca
Original Article



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.


Malignant 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.

Supplementary material

520_2016_3299_MOESM1_ESM.docx (12 kb)
ESM 1 (DOCX 12 kb)


  1. 1.
    Anthony T, Baron T, Mercadante S, Green S, Chi D, Cunningham J, Herbst A, Smart E, Krouse RS (2007) Report of the clinical protocol committee: development of randomized trials for malignant bowel obstruction. J Pain Symptom Manag 34:S49–S59CrossRefGoogle Scholar
  2. 2.
    Tuca A, Guell E, Martinez-Losada E, Codorniu N (2012) Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution. Cancer Manag Res 4:159–169CrossRefPubMedPubMedCentralGoogle Scholar
  3. 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
  4. 4.
    Mercadante S, Ferrera P, Villari P, Marrazzo A (2004) Aggressive pharmacological treatment for reversing malignant bowel obstruction. J Pain Symptom Manag 28:412–416CrossRefGoogle Scholar
  5. 5.
    Fallon MT (1994) The physiology of somatostatin and its synthetic analogue, octreotide. Eur J Palliat Care 1:20–22Google Scholar
  6. 6.
    Mercadante S, Ripamonti C, Casuccio A, Zecca E, Groff L (2000) Comparison of octreotide and hyoscine butylbromide in controlling gastrointestinal symptoms due to malignant inoperable bowel obstruction. Support Care Cancer 8:188–191CrossRefPubMedGoogle Scholar
  7. 7.
    Peng X, Wang P, Li S, Zhang G, Hu S (2015) Randomized clinical trial comparing octreotide and scopolamine butylbromide in symptom control of patients with inoperable bowel obstruction due to advanced ovarian cancer. World J Surg Oncol 13:50CrossRefPubMedPubMedCentralGoogle Scholar
  8. 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. 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
  10. 10.
    Mercadante S, Porzio G (2012) Octreotide for malignant bowel obstruction: twenty years after. Crit Rev Oncol Hematol 83:388–392CrossRefPubMedGoogle Scholar
  11. 11.
    De Conno F, Caraceni A, Zecca E, Spoldi E, Ventafridda V (1991) Continuous subcutaneous infusion of hyoscine butylbromide reduces secretions in patients with gastrointestinal obstruction. J Pain Symptom Manag 6:484–486CrossRefGoogle Scholar
  12. 12.
    O’Connor B, Creedon B (2011) Pharmacological treatment of bowel obstruction in cancer patients. Expert Opin Pharmacother 12:2205–2214CrossRefPubMedGoogle Scholar
  13. 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
  14. 14.
    Mercadante S (1998) Scopolamine butylbromide plus octreotide in unresponsive bowel obstruction. J Pain Symptom Manag 16:278–280CrossRefGoogle Scholar
  15. 15.
    Laval G, Arvieux C, Stefani L, Villard ML, Mestrallet JP, Cardin N (2006) Protocol for the treatment of malignant inoperable bowel obstruction: a prospective study of 80 cases at Grenoble University Hospital Center. J Pain Symptom Manag 31:502–512CrossRefGoogle Scholar
  16. 16.
    Currow DC, Quinn S, Agar M, Fazekas B, Hardy J, McCaffrey N, Eckermann S, Abernethy AP, Clark K (2015) Double-blind, placebo-controlled, randomized trial of octreotide in malignant bowel obstruction. J Pain Symptom Manag 49:814–821CrossRefGoogle Scholar
  17. 17.
    Porzio G, Aielli F, Verna L, Galletti B, Shoja ERG, Ficorella C (2011) Can malignant bowel obstruction in advanced cancer patients be treated at home? Support Care Cancer 19:431–433CrossRefPubMedGoogle Scholar
  18. 18.
    Hisanaga T, Shinjo T, Morita T, Nakajima N, Ikenaga M, Tanimizu M, Kizawa Y, Maeno T, Shima Y, Hyodo I (2010) Multicenter prospective study on efficacy and safety of octreotide for inoperable malignant bowel obstruction. Jpn J Clin Oncol 40:739–745CrossRefPubMedGoogle Scholar
  19. 19.
    Tuca A, Martinez E, Guell E, Gomez Batiste X (2010) Malignant bowel obstruction. Med Clin (Barc) 135:375–381CrossRefGoogle Scholar
  20. 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

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Margarita Romeo
    • 1
    • 2
    Email author
  • Maria de los LLanos Gil
    • 1
  • José Luís Cuadra Urteaga
    • 1
  • Laia Vilà
    • 1
  • Sara Ahlal
    • 1
  • Alberto Indacochea
    • 1
    • 3
  • Núria Pardo
    • 1
    • 4
  • Joaquim Radua
    • 5
    • 6
  • Albert Font
    • 1
  • Albert Tuca
    • 7
  1. 1.Medical Oncology DepartmentInstitut Català d’OncologiaBadalonaSpain
  2. 2.Universitat Autónoma de BarcelonaBarcelonaSpain
  3. 3.Center for Genomic Regulation (CRG)Vall d’Hebron Institut de RecercaBarcelonaSpain
  4. 4.Medical Oncology Department, Hospital Vall d’HebronVall d’Hebron Institut of OncologyBarcelonaSpain
  5. 5.FIDMAG Germanes Hospitalàries- CIBERSAMSant Boi de LlobregatSpain
  6. 6.Centre for Psychiatry Research, Department of Clinical NeuroscienceKarolinska InstitutetSolnaSweden
  7. 7.Supportive Care in Cancer Unit, Medical Oncology DepartmentHospital Clínic de BarcelonaBarcelonaSpain

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