Bowel obstruction in patients with metastatic cancer

Does intervention influence outcome?
  • Colette R. Pameijer
  • David M. Mahvi
  • James A. Stewart
  • Sharon M. WeberEmail author
Research Article


Background: Both surgical and nonsurgical options are available to treat bowel obstruction in patients with metastatic cancer. The goal is straightforward: to restore bowel patency and palliate the symptoms of obstruction. Yet the most appropriate management is often a challenging decision.

Aim of the Study: We sought to review our experience in managing patients with metastatic cancer and bowel obstruction.

Methods: A retrospective review was performed to identify all patients admitted at University of Wisconsin Hospital between 1993 and 2000 with the diagnoses of both bowel obstruction and metastatic cancer. Demographic data, type of management, postoperative complications, and outcome were analyzed.

Results: A total of 114 patients with primarily colorectal or gynecologic malignancies were identified. Patients’ first bowel obstructions were managed in one of two ways: (1) definitive surgical intervention (n=47), or (2) conservative management (n=67). The median overall survival was 3 mo for the entire study group. There was no significant difference in overall or obstruction-free survival based on management, presence of recurrent bowel obstruction, or type of primary cancer. The only factor that was significant in predicting poor overall survival included a disease-free interval of less than 1 yr (time of diagnosis of primary cancer to time of bowel obstruction, p=0.002).

Conclusions: Bowel obstruction in patients with metastatic cancer is a terminal event, with a 3-mo median survival. Because there is no difference in overall or obstruction-free survival based on management, the treatment for palliation of bowel obstruction in patients with metastatic cancer should be individualized.

Key Words

Bowel obstruction metastatic cancer outcome palliative care palliative surgery 


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  1. 1.
    Ripamonti C. Management of bowel obstruction in advanced cancer. Curr. Opin. Oncol. 1994;6:351–357.PubMedCrossRefGoogle Scholar
  2. 2.
    Baines MJ. The pathophysiology and management of malignant intestinal obstruction, in Oxford Textbook of Palliative Medicine. (Doyle D, Hanks GWC, MacDonald N, eds.) New York, NY: Oxford University Press; 99 A.D.:526–534.Google Scholar
  3. 3.
    Gallick HL, Weaver DW, Sachs RJ, Bouwman DL. Intestinal obstruction in cancer patients. An assessment of risk factors and outcome. Am Surg 1986;52:434–437.PubMedGoogle Scholar
  4. 4.
    Tang E, Davis J, Silberman H. Bowel obstruction in cancer patients. Arch Surg 1995;130:832–836.PubMedGoogle Scholar
  5. 5.
    Baines M, Oliver DJ, Carter RL. Medical management of intestinal obstruction in patients with advanced malignant disease. A clinical and pathological study. Lancet 1985;2:990–993.PubMedCrossRefGoogle Scholar
  6. 6.
    Yim HB, Jacobson BC, Saltzman JR, et al. Clinical outcome of the use of enteral stents for palliation of patients with malignant upper GI obstruction. Gastrointest Endo 2001;53:329–332.Google Scholar
  7. 7.
    Aranha GV, Folk FA, Greenlee HB. Surgical palliation of small bowel obstruction due to metastatic carcinoma. Am Surg 1981;47:99–102.PubMedGoogle Scholar
  8. 8.
    Butler JA, Cameron BL, Morrow M, Kahng K, Tom J. Small bowel obstruction in patients with a prior history of cancer. Am J Surg 1991;162:624–628.PubMedCrossRefGoogle Scholar
  9. 9.
    Ketcham AS, Hoye RC, Pilch YH, Morton DL. Delayed intestinal obstruction following treatment for cancer. Cancer 1970;25:406–410.PubMedCrossRefGoogle Scholar
  10. 10.
    Walsh HP, Schofield PF. Is laparotomy for small bowel obstruction justified in patients with previously treated malignancy? Brit J Surg 1984;71:933–935.PubMedCrossRefGoogle Scholar
  11. 11.
    Ellis CN, Boggs HW, Jr., Slagle GW, Cole PA. Small bowel obstruction after colon resection for benign and malignant diseases. Dis Colon Rectum 1991;34:367–371.PubMedCrossRefGoogle Scholar
  12. 12.
    Osteen RT, Guyton S, Steele G, Jr., Wilson RE. Malignant intestinal obstruction. Surgery 1980;87:611–615.PubMedGoogle Scholar
  13. 13.
    Blair SL, Chu DZ, Schwarz RE. Outcome of palliative operations for malignant bowel obstruction in patients with peritoneal carcinomatosis from nongynecological cancer. Ann Surg Oncol 2001;8:632–637.PubMedCrossRefGoogle Scholar
  14. 14.
    Weiss SM, Skibber JM, Rosato FE. Bowel obstruction in cancer patients: performance status as a predictor of survival. J Surg Oncol 1984;25:15–17.PubMedCrossRefGoogle Scholar
  15. 15.
    Stanley KE. Prognostic factors for survival in patients with inoperable lung cancer. J Natl Cancer Inst 1980;65:25–32.PubMedGoogle Scholar

Copyright information

© Humana Press Inc 2005

Authors and Affiliations

  • Colette R. Pameijer
    • 1
  • David M. Mahvi
    • 1
  • James A. Stewart
    • 2
  • Sharon M. Weber
    • 1
    Email author
  1. 1.Department of SurgeryUniversity of Wisconsin Medical School, K4/764 Clinical Science CenterMadison
  2. 2.Department of MedicineUniversity of Wisconsin Medical SchoolMadison

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