Abstract
Background
There are not guidelines for surgical management of malignant bowel obstruction (MBO) caused by peritoneal carcinomatosis (PC), mainly when it involves elderly; so its treatment is still debated.
Aim
To outline indications and benefits of palliative surgery for obstructive carcinomatosis and determine what prognostic factors, including age, have independent and significant association with outcome.
Methods
We conducted English-language MEDLINE and EMBASE searches of articles published between 1998 and 2016, which reported outcome data after palliative surgery for MBO due to PC. We excluded all articles lacking of surgical cohort and those with main interest in conservative treatment. Of 1275 articles identified, 12 satisfied selection criteria and were included in our analysis.
Results
Overall, these studies involved 548 patients undergoing palliative surgery for MBO caused by PC. The median age was 58 (range 19–93). Relief of symptoms was achieved in 26.5–100% of cases. Postoperative morbidity ranged between 7 and 44%. Mortality was high (6–22%). The median survival was longer in surgical patients than in those receiving conservative therapy (8–34 vs 4–5 weeks). Factors associated with surgery failure were poor performance status, diffuse carcinomatosis, previous radiotherapy, and obstruction of small bowel. Old age was significantly associated with a poor prognosis upon univariate analysis, while this association vanished upon multivariate analysis.
Conclusions
Surgical palliation can provide relief of obstructive symptoms as well as improved survival in well-selected patients, even if elderly.
Similar content being viewed by others
Abbreviations
- MBO:
-
Malignant bowel obstruction
- PC:
-
Peritoneal carcinomatosis
References
Bellavance EC, Alexandre HR Jr (2012) Palliative interventions in patients with peritoneal metastases and malignant bowel obstruction. J Clin Oncol 30:4290–4291
Currow DC, Quinn S, Agar M et al (2015) Double-blind, placebo- controlled, randomized trial of octreotide in malignant bowel obstruction. J Pain Symptom Manage 49:814–821
Ferguson HJM, Ferguson CI, Speakman J et al (2015) Management of intestinal obstruction in advanced malignancy. Ann Med Surg 4:264–270
Helyer L, Easson AM (2008) Surgical approaches to malignant bowel obstruction. J Support Oncol 6:105–113
Tuca A, Guell E, Martinez-Losada E (2012) Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution. Cancer Manag Res 4:159–169
Chakraborty A, Selby D, Gardiner K et al (2011) Malignant bowel obstruction: natural history of a heterogeneous patient population followed prospectively over two years. J Pain Symptom Manage 41:412–420
Wong TH, Tan YM (2009) Surgery for the palliation of intestinal obstruction in advanced abdominal malignancy. Singapore Med J 50:1139–1144
Goto T, Takano M, Aoyama T et al (2012) Outcomes of palliative bowel surgery for malignant bowel obstruction in patients with gynecological malignancy. Oncol Lett 4:883–888
Parveen Z, Qureshi AN, Akbar M et al (2009) Palliative surgery for intestinal obstruction due to recurrent ovarian cancer. J Ayub Med Coll Abbottabad 21:135–136
Kolomainen DF, Daponte A, Barton DP et al (2012) Outcomes of surgical management of bowel obstruction in relapsed epithelial ovarian cancer (EOC). Gynecol Oncol 125:31–36
Chi DS, Phaeton R, Miner TJ et al (2009) A prospective outcomes analysis of palliative procedures performed for malignant intestinal obstruction due to recurrent ovarian cancer. Oncologist 14:835–839
Mangili G, Aletti G, Frigerio L et al (2005) Palliative care for intestinal obstruction in recurrent ovarian cancer: a multivariate analysis. Int J Gynecol Cancer 15:830–835
Pothuri B, Vaidya A, Aghajanian C et al (2003) Palliative surgery for bowel obstruction in recurrent ovarian cancer: an updated series. Gynecol Oncol 89:306–313
Abbas SM, Merrie AE (2007) Resection of peritoneal metastases causing malignant small bowel obstruction. World J Surg Oncol 24:122
Legendre H, Vanhuyse F, Caroli-Bosc FX et al (2001) Survival and quality of life after palliative surgery for neoplastic gastrointestinal obstruction. Eur J Surg Oncol 27:364–367
Blair SL, Chu DZ, Schwarz RE (2001) Outcome of palliative operations for malignant bowel obstruction in patients with peritoneal carcinomatosis from nongynecological cancer. Ann Surg Oncol 8:632–637
Miller G, Boman J, Shrier I et al (2000) Small bowel obstruction secondary to malignant disease: an 11-year audit. Can J Surg 43:353–358
Perri T, Korach J, Ben-Baruch G et al (2014) Bowel obstruction in recurrent gynecologic malignancies: defining who will benefit from surgical interventions. EJSO 40:899–904
Henry JC, Pouly S, Sullivan R et al (2012) A scoring system for the prognosis and treatment of malignant bowel obstruction. Surgery 152:747–756
Williams SB, Greenspon J, Young HA et al (2005) Small bowel obstruction: conservative vs. surgical management. Dis Colon Rectum 48:1140–1146
Medina-Franco H, Garcia-Alvarez MN, Ortiz-Lopez LJ et al (2008) Predictors of adverse surgical outcome in the management of malignant bowel obstruction. Rev Invest Clin 60:212–216
Laval G, Blandine MB, Guirimand F et al (2014) Recommendations for bowel obstruction with peritoneal carcinomatosis. J Pain Symptom Manage 48:75–91
Ripamonti CI, Easson AM, Gerdes H (2008) Management of malignant bowel obstruction. Eur J Cancer 44:1105–1115
Khan MR, Hassaan B, Zafar SN et al (2011) Impact of age on outcome after colorectal cancer surgery in the elderly—a developing country perspective. BMC Surg 11:17
Khan MR, Bari H, Raza SA (2011) Early postoperative outcome after curative colorectal cancer surgery. Singapore Med J 52:195–200
Carlomagno N, Grifasi C, Dumani X et al (2013) Clinical management of Crohn’s disease in the elderly. Ann Ital Chir 84:263–267
Higashi H, Shida H, Ban K et al (2003) Factors affecting successful palliative surgery for malignant bowel obstruction due to peritoneal dissemination from colorectal cancer. Jpn J Clin Oncol 33:357–359
Shariat-Madar B, Jayakrishnan TT, Gamblin TC et al (2014) Surgical management of bowel obstruction in patients with peritoneal carcinomatosis. J Surg Oncol 110:666–669
Krouse R (2004) Invasive treatment options for malignant bowel obstructions—fast facts and concepts, p 45. http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_119.htm
Kucukmetin A, Naik R, Galaal K et al (2010) Palliative surgery versus medical management for bowel obstruction in ovarian cancer — Cochrane Database Syst Rev. doi:10.1002/14651858.CD007792.pub2
Carlomagno N, Santangelo ML, Amato B et al (2014) Total colectomy for cancer: analysis of factors linked to patients’ age. Int J Surg 12(Suppl 2):S135–S139
Olson TJP, Pinkerton C, Brasel KJ et al (2014) Palliative surgery for malignant bowel obstruction from carcinomatosis: a systematic review. JAMA Surg 149:383–392
Lee HJ, Hong SP, Cheon JH et al (2011) Long-term outcome of palliative therapy for malignant colorectal obstruction in patients with unresectable metastatic colorectal cancers: endoscopic stenting versus surgery. Gastrointest Endosc 73:535–542
Van Hooft JE, Bemelman WA, Oldenburg B et al (2011) Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomized trial. Lancet Oncol 12:344–352
Sano T (2001) Is peritoneal carcinomatosis an incurable disease or controllable locoregional condition? Challenges of surgeons with intraperitoneal hyperthermic chemotherapy. Jpn J Clin Oncol 31:571–572
Amato B, Sivero L, Vigliotti G et al (2013) Surgery for cancer in the elderly: state of the art. Chirurgia (Turin) 26:313–315
Rispoli C, Rocco N, Iannone L et al (2009) Developing guidelines in geriatric surgery: role of the grade system. BMC Geriatr 9(Suppl. 1):A99
Compagna R, Vigliotti G, Rispoli C et al (2013) Carotid screening with Duplex ultrasound in elderly asymptomatic patients candidate to general surgery. Chirurgia (Turin) 26:291–294
Amato B, Donisi M, Rispoli C et al (2013) Enhanced recovery after surgery (ERAS) program in the elderly: is it feasible? Chirurgia (Turin) 26:307–308
Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. doi:10.1371/journal.pmed1000097
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they do not have any conflict of interest.
Human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
For this type of study formal conscent is not required.
Rights and permissions
About this article
Cite this article
Santangelo, M.L., Grifasi, C., Criscitiello, C. et al. Bowel obstruction and peritoneal carcinomatosis in the elderly. A systematic review. Aging Clin Exp Res 29 (Suppl 1), 73–78 (2017). https://doi.org/10.1007/s40520-016-0656-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40520-016-0656-9