Trans-Colostomy Placement of a Button Gastrostomy Tube for Malignant Bowel Obstruction in Patients with Peritoneal Carcinomatosis

Purpose The aim of the study is to evaluate the feasibility, safety, and efficacy of the trans-colostomy placement of a button gastrostomy tube for patients with malignant bowel obstruction due to peritoneal carcinomatosis. Material and Methods Data from seven consecutive patients who presented with malignant bowel obstruction due to peritoneal carcinomatosis involving the colostomy site and underwent trans-colostomy button gastrostomy tube placement between 2013 and 2020 were retrospectively reviewed. We assessed technical and clinical success rate, procedure time, duration of improvement, and complication rate. Results The technical success rate of the trans-colostomy button gastrostomy tube placement was 100%, and average procedure time was 25 minutes. Clinical symptoms of malignant bowel obstruction resolved in four out of seven (57%) patients. Average duration of improvement in the four patients with clinical success was 170.8 days. There were no complications associated with the procedure. Conclusion Trans-colostomy button gastrostomy tube placement might be a safe and feasible treatment option for patients with malignant bowel obstruction due to peritoneal carcinomatosis.

MASCC Multidisciplinary Evidence-Based Recommendations for the Management of Malignant Bowel Obstruction in Advanced Cancer

PurposeTo provide evidence based recommendations on the management of malignant bowel obstruction (MBO) for patients with advanced cancer.MethodsThe Multinational Association for Supportive Care in Cancer (MASCC) MBO study group conducted a systematic review of databases (inception to March 2021) to identify studies about patients with advanced cancer and MBO that reported on the following outcomes: symptom management, bowel obstruction resolution, prognosis, overall survival and quality of life. The review was restricted to studies published in English but no restrictions were placed on publication year, country and study type. As per the MASCC Guidelines Policy, the findings were synthesized to determine the levels of evidence to support each MBO intervention and, ultimately, the graded recommendations and suggestions.ResultsThe systematic review identified 17,656 published studies and 397 selected for the guidelines. The MASCC study group developed a total of 25 evidence-based suggestions and recommendations about management of MBO-related nausea and vomiting, bowel movements, pain, inflammation, bowel decompression and nutrition. Expert consensus-based guidance about advanced care planning and psychosocial support is also provided.ConclusionThis MASCC guideline provides comprehensive, evidence-based recommendations about MBO management for patients with advanced cancer.

Prognostic Factors for Surgical Failure in Malignant Bowel Obstruction and Peritoneal Carcinomatosis

Introduction: Patients with peritoneal metastasis frequently develop malignant bowel obstruction (MBO). Medical palliative management is preferred but often fails. Conversely, the role of palliative surgery remains unclear and debated. This study aims to identify patients who could benefit from invasive surgical interventions and factors associated with successful surgical palliation.Materials and Methods: In this retrospective study, 98 consecutive patients who underwent palliative surgery for MBO over 5 years were reviewed. We evaluate as the primary outcome surgical failure to select patients who could benefit from palliative surgery, avoiding unnecessary surgery. A prognostic score was developed based on a logistic regression model to identify patients at risk of surgical failure. The score was evaluated for overall accuracy by receiver operating characteristic curve analysis.Results: Palliative surgery was achieved in 76 (77.5%) patients. The variables that were found to be significant factors for surgical failure are recurrent disease (P = 0.015), absence of bowel obstruction (P < 0.001), absence of bowel distension (P < 0.001), and mesenteric involvement (P = 0.001) and retraction (P < 0.001). The absence of bowel distension (P = 0.046) and bowel obstruction (P = 0.012) emerged as independent predictors of surgical failure. Carcinomatosis level assessment for peritoneum score, based on these factors, was built to evaluate the risk of surgical failure.Conclusion: Our proposed scoring system might help select patients most likely to benefit from palliative surgery.

EP.FRI.468 A review of the management of malignant bowel obstruction at an NHS teaching hospital

Patients presenting with malignant bowel obstruction (MBO) due to peritoneal metastasis present a clinical dilemma for surgeons: although palliative surgery is beneficial, post-operative complications and mortality are as high as 30%. A personalised and multi-disciplinary approach is paramount when treating these patients. Aims This study aimed to review the management (surgical versus conservative) of patients presenting with MBO; ascertain if a multi-disciplinary approach was adopted; and compare clinical outcomes including length-of-stay, readmission rates and mortality. Methods All patients admitted with MBO secondary to peritoneal metastasis between January 2019 – January 2021 were identified. Results 29 patients; 14 females, were identified with a median age 72. The median length of stay was 16 days. All patients had a CT scan and 76% were performed within 24 hours of admission. 25/29 patients were referred to palliative care. Conclusions Overall mortality and morbidity in our cohort, regardless of surgical or conservative management, is consistent with existing literature. Palliative care input was sought for the majority of patients. Management decisions should be individualised and focus on ensuring the best quality of life for the patient. All decisions should be made with multi-disciplinary input.