Challenges and outcome of surgery for bowel obstruction in women with gynaecologic cancer

Int J Surg. 2016 Mar;27:158-164. doi: 10.1016/j.ijsu.2016.02.002. Epub 2016 Feb 4.

Abstract

Introduction: Bowel obstruction is associated with a reduction in quality of life and survival among cancer patients, and the entity is traditionally treated by general surgeons without dedication to the different malignancies that cause bowel obstruction or to palliation. This study aims to identify and improve outcome of bowel obstruction in women with a history of a gynaecologic cancer.

Methods: Women operated for bowel obstruction were screened for a history of gynaecologic cancer and their records were reviewed.

Results: Bowel obstruction followed cancer treatment by a median of 18.4 months (range 2.3-277) in 59 women. A malignant cause was identified in 53% and recurrence of cancer in 61%. The cause of malignant bowel obstruction was peritoneal carcinomatosis (19%), obstructing tumour and carcinomatosis (31%) and solitary tumour (3%). Ovarian cancer (OR: 6.29, 95% CI 1.95-20.21), residual tumour during initial surgery (R2-stage) (OR: 18.7, 96% CI: 4.35-80.46) and chemotherapy (OR: 7.19, 95% CI: 2.28-22.67) were all associated with malignant bowel obstruction. Surgery solved 84% of malignant bowel obstructions, but median survival was brief (2.5 months, 95% CI: 1.4-3.6) when compared to benign bowel obstruction (95.3 months, 64.7-125.9) (p < 0.001). Readmission for bowel obstruction occurred after a median of 4.3 months (95% CI: 3.1-5.5) in surviving patients with malignant bowel obstruction and after a median of 84.5 months (95% CI: 73.6-95.3) with adhesive obstruction (p < 0.001).

Conclusions: Increased awareness of the aetiology to bowel obstruction may improve treatment strategy in these women. Women with malignant bowel obstruction should be carefully identified and differentiated in order to improve quality of life rather than pursuing emergency surgical procedures.

Keywords: Gynaecologic neoplasms; Hospital mortality; Intestinal obstruction; Palliative surgery; Palliative treatment; Postoperative complications; Surgery.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma / complications
  • Carcinoma / pathology*
  • Carcinoma / surgery
  • Cohort Studies
  • Female
  • Genital Neoplasms, Female / complications
  • Genital Neoplasms, Female / pathology*
  • Genital Neoplasms, Female / surgery
  • Humans
  • Intestinal Obstruction / etiology
  • Intestinal Obstruction / pathology
  • Intestinal Obstruction / surgery*
  • Middle Aged
  • Peritoneal Neoplasms / complications
  • Peritoneal Neoplasms / pathology*
  • Peritoneal Neoplasms / surgery
  • Quality of Life
  • Treatment Outcome