Surgical management of bowel obstruction in patients with peritoneal carcinomatosis. J Surg Oncol 2014 Nov;110(6):666-9
Date
07/06/2014Pubmed ID
24986323DOI
10.1002/jso.23707Scopus ID
2-s2.0-84912034731 (requires institutional sign-in at Scopus site) 42 CitationsAbstract
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.
Author List
Shariat-Madar B, Jayakrishnan TT, Gamblin TC, Turaga KKAuthor
Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Anastomosis, SurgicalCarcinoma
Colostomy
Humans
Intestinal Obstruction
Ostomy
Palliative Care
Peritoneal Neoplasms
Postoperative Complications
Quality of Life
