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Malignant bowel obstruction palliative surgery linked to complications, mortality
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Palliative surgery for malignant bowel obstruction from carcinomatosis alleviated symptoms in many patients but also was associated with mortality, serious complications and reobstructions, according to a study review.
Researchers screened 2,347 studies and included 17 in the analysis. The studies included 868 patients, 77% of whom were female. The median age of patients was 52 to 63 years (range, 19-90).
Benefits from surgery for malignant bowel obstruction included palliation of obstructive symptoms in 32% to 100% of patients, resumption of diet in 45% to 75% of patients, and discharge to home in 34% to 87% of patients.
However, 6% to 32% of patients died within 30 days of surgery, and 7% to 44% experienced serious surgical complications.
Reobstruction occurred in 6% to 47% of patients, 38% to 74% were readmitted for recurrent bowel obstruction, and 2% to 15% of patients underwent surgery for complications or reobstruction. Data from one study indicated that among patients who underwent a second surgery, 46% were able to return home, 46% experienced a complication and 23% died.
Median survival ranged from 26 to 273 days after diagnosis of malignant bowel obstruction.
Mean hospital length of stay for initial treatment was 12.5 to 31 days (range, 1-94). Two studies found 22% to 26% of patients spent the remainder of their lives in the hospital, and another study reported 11% of patients did so.
“Surgeons can use these data to guide decisions about the role of surgery in the setting of incurable cancer and to advance preoperative discussions by determining patient preferences about burdensome postoperative treatment with unclear benefits,” the researchers wrote. “Palliative surgery can be valuable to patients; however, surgeons who provide this treatment should not be penalized for providing comfort for the terminally ill.”
Disclosure: The researchers report no relevant financial disclosures.
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