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Obstruction-Free Survival Following Operative Intervention for Malignant Bowel Obstruction in Appendiceal Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Patients with peritoneal metastases from appendiceal cancer are at high risk of malignant bowel obstruction (MBO), which is associated with significant morbidity and mortality. There are no definitive treatment guidelines regarding operative intervention for MBO. We sought to evaluate the efficacy and safety of operative intervention in this population.

Methods

We identified patients with peritoneal metastases from appendiceal cancer who underwent surgery for MBO at our institution between 2011 and 2018. Baseline characteristics, postoperative complications, and follow-up data were collected. The primary endpoint was obstruction-free survival (OFS). Other endpoints were postoperative recovery of bowel function, 60-day Clavien–Dindo (CD) morbidity, and overall survival (OS).

Results

Twenty-six patients underwent operative treatment for MBO, of whom 14 had high-grade (HG) histology and 12 had low-grade (LG) histology. Seven (25.9%) patients had severe (CD grade 3 or higher) 60-day complications, including one (3.8%) postoperative death. All remaining patients had return of bowel function and resumed oral intake during hospitalization. Six (23.1%) patients had repeat admissions for MBO after surgery. Median OFS was 17.0 months (95% confidence interval [CI] 2.3–31.8), and median OS was 18.5 months (95% CI 3.6–33.3) following surgery.

Conclusion

In this carefully selected group of patients with peritoneal metastases from appendiceal cancer, surgery for MBO provided durable palliation with acceptable morbidity.

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Acknowledgment

This study was supported by a University of California San Diego Clinical and Translational Research Institute Grant (UL1TR001442).

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Authors and Affiliations

  1. Department of Surgery, University of California, San Diego Moores Cancer Center, La Jolla, CA, USA

    Joel M. Baumgartner MD, MAS, Rebecca Marmor MD, Athena Hsu BS, Jula Veerapong MD, Kaitlyn J. Kelly MD & Andrew M. Lowy MD

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  1. Joel M. Baumgartner MD, MAS
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  2. Rebecca Marmor MD
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  3. Athena Hsu BS
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  4. Jula Veerapong MD
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  5. Kaitlyn J. Kelly MD
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  6. Andrew M. Lowy MD
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Corresponding author

Correspondence to Joel M. Baumgartner MD, MAS.

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Disclosures

Joel M. Baumgartner, Rebecca Marmor, Athena Hsu, Jula Veerapong, Kaitlyn J. Kelly, and Andrew M. Lowy have no disclosures or relevant conflicts of interest to declare.

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Baumgartner, J.M., Marmor, R., Hsu, A. et al. Obstruction-Free Survival Following Operative Intervention for Malignant Bowel Obstruction in Appendiceal Cancer. Ann Surg Oncol 26, 3611–3617 (2019). https://doi.org/10.1245/s10434-019-07507-4

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  • DOI: https://doi.org/10.1245/s10434-019-07507-4

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