Surgery improves symptoms for patients with advanced cancer, malignant bowel obstruction
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Key takeaways:
- Researchers observed no significant difference in mean number of “good days” in the surgery vs. no-surgery groups.
- Results showed better symptom severity scores in the surgery group.
Surgery did not significantly increase the number of “good days” among patients with advanced cancer and malignant small bowel obstruction, according to study results.
However, patients who underwent surgery reported improvement in malignant bowel obstruction-related symptoms by 3 months after trial registration, findings published in The Lancet Gastroenterology & Hepatology showed.
“We knew enrolling patients in the hospital with this acute issue and advanced cancer would be difficult, but the questions are of great importance to clinicians, patients and families,” Robert S. Krouse, MD, professor of surgery at Perelman School of Medicine at University of Pennsylvania, said in a press release. “Based on the results, we believe surgically eligible patients with [malignant bowel obstruction] should be offered an operation earlier in their hospital stay to improve their symptoms, even though these results suggest it will not increase their number of days alive and out of the hospital.”
Background and methodology
Many patients with advanced abdominal tumors — such as colorectal or ovarian cancers — develop partial or complete blockage of the bowel. This can be caused by the tumors, or by complications from radiation or surgery.
Patients with malignant bowel obstruction typically have a poor prognosis and endure multiple related symptoms, with no optimal treatment approach.
Krouse and colleagues conducted S1316 — a pragmatic comparative effectiveness trial — to compare surgical vs. nonsurgical management of patients with malignant bowel obstruction.
The trial — conducted at 30 hospitals or cancer research centers in four countries — included 199 evaluable patients aged 18 years or older.
Eligible patients had intra-abdominal or retroperitoneal primary cancer and malignant bowel disease, with a surgical indication and Zubrod performance status between 0 and 2 within 1 week before admission.
A randomized pathway included 49 patients (surgery, n = 24; no surgery, n = 25). A “patient choice” pathway included 150 patients (surgery, n = 58; no surgery, n = 92).
“Good days” — defined as number of days alive and out of the hospital — after 3 months served as the primary outcome.
Results
Results showed no statistically significant difference in good days between the surgery and no-surgery groups in either the randomized pathway (mean, 42.6 days vs. 43.9 days) or patient choice pathway (mean, 54.8 days vs. 52.7 days).
Researchers calculated an adjusted mean difference of 2.9 additional good days (95% CI, 5.5-11.3) with surgery.
During initial hospital stays, five participants died due to cancer progression and one died due to malignant bowel obstruction treatment complications.
Researchers reported poor OS during the primary follow-up period, with fewer than half (47%) of patients surviving at least 91 days (median OS, 86 days).
Patients who underwent surgery exhibited fewer malignant bowel obstruction-related symptoms, displaying better severity scores for vomiting, constipation, nausea and pain at week 4 than those who did not undergo surgery.
Patients who underwent surgery reported fewer malignant bowel obstruction-related symptoms after leaving hospital, as well.
The most common grade 3 to grade 4 malignant bowel obstruction treatment complication was anemia. This occurred among 6% of patients in the randomized pathway who underwent surgery and 5% of those in the patient choice pathway (surgery, n = 4; no surgery, n = 1).
Next steps
Although researchers did not notice a benefit between the two groups through the primary outcome, they still concluded patients should undergo surgery as early as possible to minimize potentially life-threatening symptoms.
“We are continuing to analyze the data to allow us to make recommendations to clinicians regarding the optimal operations and other quality-of-life factors that may be impacted by the type of treatment received,” Krouse said in the release. “Our network of institutions and investigators will allow us to examine other important [questions] in this population of cancer survivors.”
References:
- Krouse RS, et al. Lancet Gastroenterol Hepatol. 2023;doi:10.1016/S2468-1253(23)00191-7.
- Results of large pragmatic trial will help guide treatment of malignant bowel obstruction in patients with advanced cancer (press release). Available at: https://www.eurekalert.org/news-releases/997277. Published Aug. 1, 2023. Accessed Aug. 2, 2023.
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