Surgical management of bowel obstruction in patients with peritoneal carcinomatosis

Background Due to low life expectancy, treatment strategies for malignant bowel obstruction (MBO) due to peritoneal carcinomatosis (PC) emphasize improved quality of life and symptom relief. Currently, the value of palliative surgery to treat obstructive PC is unclear. Methods A prospectively regist...

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Bibliographic Details
Published in:Journal of surgical oncology 2014-11, Vol.110 (6), p.666-669
Main Authors: Shariat-Madar, Bahbak, Jayakrishnan, Thejus T., Gamblin, T. Clark, Turaga, Kiran K.
Format: Article
Language:English
Subjects:
Anastomosis, Surgical
Carcinoma - complications
Carcinoma - mortality
Carcinoma - surgery
Colostomy
Humans
intestinal bypasses
Intestinal Obstruction - etiology
Intestinal Obstruction - surgery
neoplasms
Ostomy
Palliative Care
Peritoneal Neoplasms - complications
Peritoneal Neoplasms - mortality
Peritoneal Neoplasms - surgery
Postoperative Complications
Quality of Life
stents
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Summary:Background Due to low life expectancy, treatment strategies for malignant bowel obstruction (MBO) due to peritoneal carcinomatosis (PC) emphasize improved quality of life and symptom relief. Currently, the value of palliative surgery to treat obstructive PC is unclear. Methods A prospectively registered search strategy (PROSPERO) was utilized to identify articles examining outcomes of patients undergoing surgical palliation for MBO from PC in PubMed (2003–2013). Primary outcomes of interest were median overall survival (OS) and treatment complications. Results Of 730 articles screened, 64 were selected for full‐text review and 5 were quantitatively synthesized. This comprised 313 patients with MBO, of which 249 (79.5%) presented with PC. The mean age was 61.4 years (range 51–67). The OS for surgical patients was 6.4 months (2.8–19.7, n = 190). Stratification by surgical technique suggested an OS of resection, ostomy, and enteral bypass as 7.2 months (n = 174), 3.4 months (n = 9), and 2.7 months (n = 7), respectively. Major complications occurred in 37.0% of patients that underwent resection. Conclusions This study supports surgical resection over surgical bypass to treat obstructive PC, as it offered better OS with fewer complications. Higher quality studies are needed to conclusively assess the role of surgery in patients with obstructive PC. J. Surg. Oncol. 2014 110:666–669. © 2014 Wiley Periodicals, Inc.
ISSN:0022-4790
1096-9098
DOI:10.1002/jso.23707