Abstract
Background:Malignant bowel obstruction (MBO) secondary to peritoneal carcinomatosis carries a grave prognosis. We evaluated clinicopathologic factors that predict outcomes after palliative operations for MBO.
Methods:Data on patients undergoing laparotomy for palliation of gastrointestinal MBO at City of Hope between 1995 and 2000 were retrospectively collected. Successful palliation was defined as the ability to tolerate solid food (TSF).
Results:Sixty-three patients underwent operative treatment. In 20 patients, MBO was the first presentation of disease; for others, the median disease-free interval was 15 months. The complication rate was 44%, and postoperative mortality was 15%. The median length of stay was 12 days. Twenty-nine patients (45%) were discharged from the hospital on a regular diet; 22 (76%) continued to eat until their last follow-up. Median survival was 90 days. Univariate factors for longer survival were TSF on discharge, colorectal primary, and nonmetastatic status at first diagnosis. Patients with ascites and whose cancer first presented with MBO had an inferior survival. Noncolorectal primary remained a multivariate predictor for decreased survival. TSF was predicted by the absence of ascites, an obstruction not involving the small bowel, and a preoperative albumin of >3.0 mg/dl. Multiple logistic regression analysis yielded presence of ascites and small-bowel obstruction as predictors of inability to TSF.
Conclusions:Only one third of patients with MBO from peritoneal carcinomatosis will have prolonged postoperative palliation with significant, but acceptable, treatment-related morbidity. TSF at discharge is a useful predictor of continued palliation for most patients. Patients with colorectal cancer may have superior survival outcome and better palliation; others are at risk for poor outcomes, especially in the presence of ascites and MBO of small bowel. In these patients, highly selective use of laparotomy is recommended.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Sampson JA. Implantation peritoneal carcinomatosis of ovarian origin. Am J Pathol 1931;7:691–693.
Sadeghi B, Arvieux C, Glehen O, et al. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 2000;88:358–363.
Heys SD, Smith I, Eremin O. The management of patients with advanced cancer (II). Eur J Surg Oncol 1997;23:257–263.
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.
Edna TH, Bjerkeset T. Small bowel obstruction in patients previously operated on for colorectal cancer. Eur J Surg 1998;164:587–592.
Schwarz RE, Karpeh MS, Brennan MF. Factors predicting hospitalization after operative treatment for gastric carcinoma in patients older than 70 years. J Am Coll Surg 1997;184:9–15.
Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. Am Stat Assoc J 1958;53:457–481.
Peto R, Pike MC. Conservatism in the approximation E(0-E)2/E in the log rank test for survival data or tumor incidence data. Biometrics 1973;29:579–584.
Cox DR. Regression models and life tables. J R Stat Assoc 1972;29:187–220.
Averbach AM, Sugarbaker PH. Recurrent intraabdominal cancer with intestinal obstruction. Int Surg 1995;80:141–146.
Sugarbaker PH, Jablonski KA. Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann Surg 1995;221:124–132.
Turnbull AD, Guerra J, Starnes HF. Results of surgery for obstructing carcinomatosis of gastrointestinal, pancreatic, or biliary origin. J Clin Oncol 1989;7:381–386.
Lau PW, Lorentz TG. Results of surgery for malignant bowel obstruction in advanced, unresectable, recurrent colorectal cancer. Dis Colon Rectum 1993;36:61–64.
Walsh HP, Schofield PF. Is laparotomy for small bowel obstruction justified in patients with previously treated malignancy?. Br J Surg 1984;71:933–935.
Woolfson RG, Jennings K, Whalen GF. Management of bowel obstruction in patients with abdominal cancer. Arch Surg 1997;132:1093–1097.
Chu DZ, Lang NP, Thompson C, Osteen PK, Westbrook KC. Peritoneal carcinomatosis in nongynecologic malignancy. A prospective study of prognostic factors. Cancer 1989;63:364–367.
Tang E, Davis J, Silberman H. Bowel obstruction in cancer patients. Arch Surg 1995;130:832–6; discussion 836ndash;7.
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.
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.
Gemlo B, Rayner AA, Lewis B, et al. Home support of patients with end-stage malignant bowel obstruction using hydration and venting gastrostomy. Am J Surg 1986;152:100–104.
Khoo D, Hall E, Motson R, Riley J, Denman K, Waxman J. Palliation of malignant intestinal obstruction using octreotide. Eur J Cancer 1994;1:28–30.
Mangili G, Franchi M, Mariani A, et al. Octreotide in the management of bowel obstruction in terminal ovarian cancer. Gynecol Oncol 1996;61:345–348.
Ventafridda V, Ripamonti C, Caraceni A, Spoldi E, Messina L, De Conno F. The management of inoperable gastrointestinal obstruction in terminal cancer patients. Tumori 1990;76:389–393.
Jong P, Sturgeon J, Jamieson CG. Benefit of palliative surgery for bowel obstruction in advanced ovarian cancer. Can J Surg 1995;38:454–457.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Blair, S.L., Chu, D.Z.J. & Schwarz, R.E. Outcome of Palliative Operations for Malignant Bowel Obstruction in Patients With Peritoneal Carcinomatosis From Nongynecological Cancer. Ann Surg Oncol 8, 632–637 (2001). https://doi.org/10.1007/s10434-001-0632-1
Issue Date:
DOI: https://doi.org/10.1007/s10434-001-0632-1