Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2020; 12(3): 323-331
Published online Mar 15, 2020. doi: 10.4251/wjgo.v12.i3.323
Surgical intervention for malignant bowel obstruction caused by gastrointestinal malignancies
Peng-Ju Chen, Lin Wang, Yi-Fan Peng, Nan Chen, Ai-Wen Wu
Peng-Ju Chen, Lin Wang, Yi-Fan Peng, Nan Chen, Ai-Wen Wu, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Cancer Center, Unit III, Peking University Cancer Hospital and Institute, Beijing 100142, China
Author contributions: Chen PJ, Wang L and Peng YF contributed equally to this work; Chen PJ and Wang L designed research; Peng YF performed research; Chen N analyzed data; Chen PJ, Peng YF and Wu AW wrote the paper.
Supported by National Natural Science Foundation of China, No. 81773214.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Peking University Cancer Hospital and Institute, approval No. 2019YJZ46.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data.
Conflict-of-interest statement: The authors have nothing to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ai-Wen Wu, MD, PhD, Full Professor, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Cancer Center, Unit III, Peking University Cancer Hospital and Institute, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. wuaw@sina.com
Received: September 27, 2019
Peer-review started: September 27, 2019
First decision: November 18, 2019
Revised: November 27, 2019
Accepted: January 14, 2020
Article in press: January 14, 2020
Published online: March 15, 2020
Abstract
BACKGROUND

Malignant bowel obstruction (MBO) is a common event for end-stage gastrointestinal cancer patients. Previous studies had demonstrated manifestations and clinical management of MBO with mixed malignancies. There still lack reports of the surgical treatment of MBO.

AIM

To analyze the short-term outcomes and prognosis of palliative surgery for MBO caused by gastrointestinal cancer.

METHODS

A retrospective chart review of 61 patients received palliative surgery between January 2016 to October 2018 was performed, of which 31 patients underwent massive debulking surgery (MDS) and 30 underwent ostomy/by-pass surgery (OBS). The 60-d symptom palliation rate, 30-d morbidity and mortality, and overall survival rates were compared between the two groups.

RESULTS

The overall symptom palliation rate was 75.4% (46/61); patients in the MDS group had significantly higher symptom palliation rate than OBS group (90% vs 61.2%, P = 0.016). Patients with colorectal cancer who were in the MDS group showed significantly higher symptom improvement rates compared to the OBS group (overall, 76.4%; MDS, 61.5%; OBS, 92%; P = 0.019). However, patients with gastric cancer did not show a significant difference in symptom palliation rate between the MDS and OBS groups (OBS, 60%; MDS, 80%; P = 1.0). The median survival time in the MDS group was significantly longer than in the OBS group (10.9 mo vs 5.3 mo, P = 0.05).

CONCLUSION

For patients with MBO caused by peritoneal metastatic colorectal cancer, MDS can improve symptom palliation rates and prolong survival, without increasing mortality and morbidity rates.

Keywords: Gastrointestinal neoplasms, Malignant bowel obstruction, Metastasis, Palliative surgery, Prognosis, Quality of life

Core tip: Malignant bowel obstruction (MBO) is a frequent event for patients with end-stage gastrointestinal cancer. There is no consensus on the optimal treatment strategy for improving quality of life and prolonging survival. We performed a retrospective study at a single institution to determine the effects of palliative surgery for MBO in patients with gastrointestinal cancers. In this cohort, we observed higher symptom relief rates and prolonged survival after massive debulking surgery compared with ostomy/by-pass surgery in MBO patients. For select patients with MBO caused by metastatic colorectal cancer, massive debulking surgery can result in higher symptom palliation rates and prolonged survival without increasing mortality and morbidity rates compared with ostomy/by-pass surgery.