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Bowel Obstruction in Cancer Patients

Bowel Obstruction in Cancer Patients Abstract Objective: To examine the efficacy of various interventions on bowel obstruction occurring in patients with a history of cancer. Design: Retrospective case series. Setting: A university comprehensive cancer center. Patients: Sixty-one patients presenting with 81 episodes of intestinal obstruction. Results: Sixty-nine episodes of obstruction affected the small bowel, including 24 complete obstructions. There were 12 episodes of large-bowel obstruction, eight of which were complete. Five patients (8.2%) had concurrent small- and large-bowel obstruction. In 59 cases, the cause was established: 36 (61%) were due to metastatic tumor and 23 (39%) were due to benign conditions. Of the 49 episodes of partial bowel obstruction, 42 (86%) initially were treated medically. Nineteen (45%) of these 42 cases of obstruction resolved after 8.7±11.1 days (mean±SD) of conservative management. Twenty-two patients with partial obstruction were treated surgically, with relief of obstruction in 15 cases (68%). Of the 32 episodes of complete obstruction, 26 (81%) were initally managed conservatively; in only one case (3.8%) did obstruction resolve. Surgery successfully relieved the obstruction in 16 (76%) of 21 patients. Twenty-six patients received parenteral nutrition at home as the major treatment for obstruction; 22 (85%) experienced relief of nausea and vomiting. Patients with malignant obstructions survived 0 to 24 months (median, 4.7 months); the median survival for those treated surgically was 5.0 months. Conclusions: In patients with a history of cancer, partial obstruction (but not complete obstruction) frequently resolves with medical management. Surgical intervention relieves most cases of partial or complete obstruction regardless of benign or malignant cause, but survival often is limited in the latter group. The entire intestinal tract should be evaluated in all patients, since 8.2% of patients in this series had concurrent small- and large-bowel obstructions. Home parenteral nutrition often provides symptomatic palliation in patients not amenable to surgical relief.(Arch Surg. 1995;130:832-837) References 1. Ripamonti C, Conno FD, Ventafridda V, Rossi B, Baines MF. Management of bowel obstruction in advanced and terminal cancer patients . Ann Oncol . 1993:4:15-21. 2. Aabo K, Pederson H, Bach F, Knudsen J. Surgical management of intestinal obstruction in the late course of malignant disease . Acta Chir Scand . 1984; 150:173-176. 3. Turnbull ADM, Guerra J, Starnes HF. Results of surgery for obstructing carcinomatosis of gastrointestinal, pancreatitc, or biliary origin . J Clin Oncol . 1989:7:381-386. 4. Assalia A, Schein M, Kopelman D, et al. Therapeutic effect of oral Gastrografin in adhesive, partial small bowel obstruction: a prospective randomized trial . Surgery . 1994;115:433-437. 5. 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.Crossref 6. 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.Crossref 7. Silberman H. Parenteral and Enteral Nutrition . 2nd ed. Norwalk, Conn: Appleton & Lange; 1989:350-351. 8. 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.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Bowel Obstruction in Cancer Patients

Archives of Surgery , Volume 130 (8) – Aug 1, 1995

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References (7)

Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1995.01430080034004
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To examine the efficacy of various interventions on bowel obstruction occurring in patients with a history of cancer. Design: Retrospective case series. Setting: A university comprehensive cancer center. Patients: Sixty-one patients presenting with 81 episodes of intestinal obstruction. Results: Sixty-nine episodes of obstruction affected the small bowel, including 24 complete obstructions. There were 12 episodes of large-bowel obstruction, eight of which were complete. Five patients (8.2%) had concurrent small- and large-bowel obstruction. In 59 cases, the cause was established: 36 (61%) were due to metastatic tumor and 23 (39%) were due to benign conditions. Of the 49 episodes of partial bowel obstruction, 42 (86%) initially were treated medically. Nineteen (45%) of these 42 cases of obstruction resolved after 8.7±11.1 days (mean±SD) of conservative management. Twenty-two patients with partial obstruction were treated surgically, with relief of obstruction in 15 cases (68%). Of the 32 episodes of complete obstruction, 26 (81%) were initally managed conservatively; in only one case (3.8%) did obstruction resolve. Surgery successfully relieved the obstruction in 16 (76%) of 21 patients. Twenty-six patients received parenteral nutrition at home as the major treatment for obstruction; 22 (85%) experienced relief of nausea and vomiting. Patients with malignant obstructions survived 0 to 24 months (median, 4.7 months); the median survival for those treated surgically was 5.0 months. Conclusions: In patients with a history of cancer, partial obstruction (but not complete obstruction) frequently resolves with medical management. Surgical intervention relieves most cases of partial or complete obstruction regardless of benign or malignant cause, but survival often is limited in the latter group. The entire intestinal tract should be evaluated in all patients, since 8.2% of patients in this series had concurrent small- and large-bowel obstructions. Home parenteral nutrition often provides symptomatic palliation in patients not amenable to surgical relief.(Arch Surg. 1995;130:832-837) References 1. Ripamonti C, Conno FD, Ventafridda V, Rossi B, Baines MF. Management of bowel obstruction in advanced and terminal cancer patients . Ann Oncol . 1993:4:15-21. 2. Aabo K, Pederson H, Bach F, Knudsen J. Surgical management of intestinal obstruction in the late course of malignant disease . Acta Chir Scand . 1984; 150:173-176. 3. Turnbull ADM, Guerra J, Starnes HF. Results of surgery for obstructing carcinomatosis of gastrointestinal, pancreatitc, or biliary origin . J Clin Oncol . 1989:7:381-386. 4. Assalia A, Schein M, Kopelman D, et al. Therapeutic effect of oral Gastrografin in adhesive, partial small bowel obstruction: a prospective randomized trial . Surgery . 1994;115:433-437. 5. 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.Crossref 6. 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.Crossref 7. Silberman H. Parenteral and Enteral Nutrition . 2nd ed. Norwalk, Conn: Appleton & Lange; 1989:350-351. 8. 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.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Aug 1, 1995

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