Comparison of common risk stratification indices to predict outcomes among stage IV cancer patients with bowel obstruction undergoing surgery

Comparison of common risk stratification indices to predict outcomes among stage IV cancer... INTRODUCTIONMalignant bowel obstruction is common among patients with advanced malignancy with incidence rates of 28‐51% for gastrointestinal and gynecological cancers. This condition may signify a terminal event with an associated median life expectancy of 4 months. Therefore, goals of care for this high‐risk population are palliative requiring careful consideration of patient quality of life through either medical or surgical treatment approaches. Despite the potential palliative benefits of surgery for patients with malignant bowel obstruction, surgery is associated with rates of serious complications as high as 44%. Furthermore, these patients are at risk for prolonged hospitalization which may consume a considerable percentage of their limited life expectancy. Therefore, careful surgical risk stratification is essential for informed consent prior to proceeding with surgical intervention.Traditional methods of operative risk stratification include the American Society of Anesthesiologist (ASA) physical status classification and the Charlson comorbidity index (CCI). In addition, a growing body of research has demonstrated the use of measures of frailty, including the modified frailty index (mFI), to predict postoperative morbidity and mortality for numerous surgical interventions including pancreatectomy, hepatectomy, and colorectal surgery. Frailty is defined as decreased physiologic reserve and, therefore, increased vulnerability to disability due to inability to withstand stressors. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Surgical Oncology Wiley

Comparison of common risk stratification indices to predict outcomes among stage IV cancer patients with bowel obstruction undergoing surgery

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Publisher
Wiley
Copyright
© 2018 Wiley Periodicals, Inc.
ISSN
0022-4790
eISSN
1096-9098
D.O.I.
10.1002/jso.24866
Publisher site
See Article on Publisher Site

Abstract

INTRODUCTIONMalignant bowel obstruction is common among patients with advanced malignancy with incidence rates of 28‐51% for gastrointestinal and gynecological cancers. This condition may signify a terminal event with an associated median life expectancy of 4 months. Therefore, goals of care for this high‐risk population are palliative requiring careful consideration of patient quality of life through either medical or surgical treatment approaches. Despite the potential palliative benefits of surgery for patients with malignant bowel obstruction, surgery is associated with rates of serious complications as high as 44%. Furthermore, these patients are at risk for prolonged hospitalization which may consume a considerable percentage of their limited life expectancy. Therefore, careful surgical risk stratification is essential for informed consent prior to proceeding with surgical intervention.Traditional methods of operative risk stratification include the American Society of Anesthesiologist (ASA) physical status classification and the Charlson comorbidity index (CCI). In addition, a growing body of research has demonstrated the use of measures of frailty, including the modified frailty index (mFI), to predict postoperative morbidity and mortality for numerous surgical interventions including pancreatectomy, hepatectomy, and colorectal surgery. Frailty is defined as decreased physiologic reserve and, therefore, increased vulnerability to disability due to inability to withstand stressors.

Journal

Journal of Surgical OncologyWiley

Published: Jan 1, 2018

Keywords: ; ; ; ;

References

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