Palliative surgery for malignant gastrointestinal obstruction: A community hospital experience

Abstract Background and study aims Management of malignant gastrointestinal obstruction (MGIO) is more challenging in the presence of peritoneal carcinomatosis (PC). Outcomes data to guide the management of MGIO with PC are lacking. We aimed to compare the clinical outcomes and adverse events between endoscopic and surgical palliation and identify predictors of stent success in patients with MGIO with PC. Patients and methods Consecutive inpatients with MGIO with PC between 2000 and 2018 who underwent palliative surgery or enteral stenting were included. Clinical success was defined as relief of obstructive symptoms. Results Fifty-seven patients with enteral stenting and 40 with palliative surgery were compared. The two groups did not differ in rates of technical success, 30-day mortality, or recurrence. Clinical success from a single intervention (63.2 % versus 95 %), luminal patency duration (27 days vs. 145 days), and survival length (148 days vs. 336 days) favored palliative surgery (all P < 0.05) but the patients in the surgery group had a trend toward better Eastern Cooperative Oncology Group (ECOG) status. The rate of adverse events (AEs) (10.5 % vs. 50 %), the severity of AEs, and length of hospital stay (4.5 days vs. 9 days) favored enteral stenting (P < 0.05). The need for more than one stent was associated with a higher likelihood of stent failure. Conclusions Our study suggests that enteral stenting is safer and associated with a shorter hospital stay than palliative surgery, although unlike other MGIOs, clinical success is lower in MGIO with PC. Identification of the right candidates and potential predictors of clinical success in ECOG-matched large-scale studies is needed to validate these results.

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Su1034 OUTCOMES OF PALLIATIVE TREATMENT FOR MALIGNANT GASTROINTESTINAL OBSTRUCTION WITH PERITONEAL CARCINOMATOSIS: STENT PLACEMENT VERSUS PALLIATIVE SURGERY AND PREDICTORS OF STENT FAILURE

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2020.03.1880 ◽

2020 ◽

Vol 91 (6) ◽

pp. AB275

Author(s):

Veeravich Jaruvongvanich ◽

F.N.U. Chesta ◽

Meher Oberoi ◽

Navtej S. Buttar

Keyword(s):

Peritoneal Carcinomatosis ◽

Stent Placement ◽

Palliative Treatment ◽

Palliative Surgery ◽

Gastrointestinal Obstruction ◽

Malignant Gastrointestinal Obstruction

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Malignant Gastrointestinal Obstruction: Options for Decompression and Nutrition

Digestive Disease Interventions ◽

10.1055/s-0040-1718390 ◽

2020 ◽

Vol 04 (03) ◽

pp. 311-322

Author(s):

Robert J. Litwin ◽

Johanna L. Chan ◽

Steven Y. Huang

Keyword(s):

Clinical Presentation ◽

Practice Patterns ◽

Patient Care Team ◽

Therapeutic Interventions ◽

Collaborative Approach ◽

Malignant Bowel Obstruction ◽

Advanced Malignancy ◽

Gastrointestinal Obstruction ◽

Malignant Gastrointestinal Obstruction

AbstractMalignant bowel obstruction (MBO) is a relatively common condition affecting patients with advanced malignancy. Therapeutic interventions should be aimed at maintaining quality of life. Given the lack of prospective controlled studies in this patient population, patient management is often based on local practice patterns and anecdotal experience. To foster a collaborative approach among the members of the patient care team involving internal medicine, oncology, palliative care, clinical nutrition, surgery, gastroenterology, and interventional radiology physicians, it is important to improve our understanding of MBO. The purpose of this article is to describe the clinical presentation, pathophysiology, as well as medical, surgical, and nonsurgical palliative options available to patients with MBO for purposes of decompression and nutrition.

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