Management of patients with malignant bowel obstruction and stage IV colorectal cancer Journal Article

Authors: Dalal, K. M.; Gollub, M. J.; Miner, T. J.; Wong, W. D.; Gerdes, H.; Schattner, M. A.; Jaques, D. P.; Temple, L. K. F.
Article Title: Management of patients with malignant bowel obstruction and stage IV colorectal cancer
Abstract: Background: Malignant bowel obstruction (MBO), a serious problem in stage IV colorectal cancer (CRC) patients, remains poorly understood. Optimal management requires realistic assessment of treatment goals. This study's purpose is to characterize outcomes following palliative intervention for MBO in the setting of metastatic CRC. Study Design: Retrospective review of a prospective palliative database identified 141 patients undergoing surgical (OR; n = 96) or endoscopic (GI; n = 45) procedures for symptoms of MBO. Results: Median patient age was 58 years, median follow-up 7 months. Most (63%) had multiple sites of metastases. Computed tomography (CT) scan findings of carcinomatosis (p = 0.002), ascites (p = 0.05), and multifocal obstruction with carcinomatosis and ascites (p = 0.03) significantly predicted the need for percutaneous or open gastrostomy tube, or stoma. Procedure-associated morbidity for 81 patients with small bowel obstruction (SBO) was 37%; 7% developed an enterocutaneous fistula/anastomotic leak. Thirty-day mortality was 6%. Most (84%) patients were palliated successfully; some received additional chemotherapy (38%) or surgery (12%). Procedure-associated morbidity for 60 patients with large bowel obstruction (LBO) was 25%; 11 patients (18%) required other procedures for stent failure, with one death at 30 days. Symptom resolution was >97%. Patients with LBO had improved symptom resolution, shorter length of stay (LOS), and longer median survival than patients with SBO. Conclusions: Patients with MBO and stage IV CRC were successfully palliated with GI or OR procedures. Patients with CT-identified ascites, carcinomatosis, or multifocal obstruction were least likely to benefit from OR procedures. CT plays an important role in preoperative planning. Sound clinical judgment and improved understanding are required for optimal management of MBO. © 2011, Mary Ann Liebert, Inc.
Keywords: adult; cancer chemotherapy; cancer survival; treatment outcome; aged; cancer surgery; major clinical study; mortality; stomach tube; ascites; treatment duration; cancer adjuvant therapy; cancer radiotherapy; cancer staging; follow up; cancer palliative therapy; colorectal cancer; metastasis; computer assisted tomography; morbidity; retrospective study; prediction; patient care; stoma; endoscopic surgery; intestine resection; intestine obstruction; gastrointestinal endoscopy; small intestine obstruction; carcinomatosis; anastomosis leakage; enterocutaneous fistula; large intestine disease; large intestine obstruction; malignant intestine obstruction
Journal Title: Journal of Palliative Medicine
Volume: 14
Issue: 7
ISSN: 1096-6218
Publisher: Mary Ann Liebert, Inc  
Date Published: 2011-06-23
Start Page: 822
End Page: 828
Language: English
DOI: 10.1089/jpm.2010.0506
PROVIDER: scopus
PUBMED: 21595546
Notes: --- - "Export Date: 17 August 2011" - "CODEN: JPAMF" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Hans Gerdes
    164 Gerdes
  2. Marc J Gollub
    172 Gollub
  3. David P Jaques
    66 Jaques
  4. Kimberly Ann Dalal
    15 Dalal
  5. Larissa Temple
    192 Temple
  6. Mark Schattner
    132 Schattner
  7. Douglas W Wong
    177 Wong