Bowel obstruction in advanced malignancies: An evaluation of patient outcomes at a tertiary cancer centre

Abstract

Background: Malignant bowel obstruction (MBO) is a highly morbid complication of advanced intra-abdominal malignancies. This study aims to identify clinicopathologic factors and intervention strategies associated with improved survival and reduced rates of re-obstruction.

Methods: A single centre, retrospective data analysis was performed for all consecutive patients admitted with MBO to a tertiary cancer centre in Melbourne, Australia over a 2-year period.

Results: We identified a total of 102 patients with 137 admission episodes for MBO. Median age was 62 years, and 55 patients (54%) were female. 61 patients (60%) had a gastrointestinal primary (colorectal, gastric or appendiceal), while 17 patients (16%) had a gynaecological primary and 24 (24%) other primaries. Median overall survival was 120 days (95% confidence interval (CI) [76, 167]). 41 patients (40%) died within 90 days of initial admission with MBO. Clinicopathological variables associated with reduced 90-day survival included hypoalbuminaemia (odds ratio [OR] = 3.33 for serum albumin < 30 g/L, 95% CI [1.43, 7.69]) and peritoneal disease (OR = 5.80, 95% CI [2.26, 14.9]). 41 patients (40%) received surgical management. We identified no factors significantly associated with the decision for surgical rather than conservative management. Of the 113 total admissions that reached discharge, 55 (49%) were followed by patient readmission within 90 d. Almost half (48%) of patients were referred to the inpatient palliative care service and this was associated with a reduction in the odds of 90 d readmission (OR = 0.31, 95% CI [0.14, 0.71]).

Conclusion: MBO heralds a poor prognosis, with high rates of readmission, morbidity and mortality. Careful patient selection is imperative to identify patients likely to benefit from operative management.

Keywords

bowel obstruction / cancer / abdominal malignancy / palliative care / surgery

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The Author(s). Malignancy Spectrum published by John Wiley & Sons Australia, Ltd on behalf of Higher Education Press.