Bowel obstruction in cancer patients
E. Tang, J. Davis and H. Silberman
Department of Surgery, University of Southern California (USC), School of Medicine, Los Angeles, USA.
OBJECTIVE: To examine the efficacy of various interventions on bowel
obstruction occurring in patients with a history of cancer. DESIGN:
Retrospective case series. SETTING: A university comprehensive cancer
center. PATIENTS: Sixty-one patients presenting with 81 episodes of
intestinal obstruction. RESULTS: Sixty-nine episodes of obstruction
affected the small bowel, including 24 complete obstructions. There were 12
episodes of large-bowel obstruction, eight of which were complete. Five
patients (8.2%) had concurrent small- and large-bowel obstruction. In 59
cases, the cause was established: 36 (61%) were due to metastatic tumor and
23 (39%) were due to benign conditions. Of the 49 episodes of partial bowel
obstruction, 42 (86%) initially were treated medically. Nineteen (45%) of
these 42 cases of obstruction resolved after 8.7 +/- 11.1 days (mean +/-
SD) of conservative management. Twenty-two patients with partial
obstruction were treated surgically, with relief of obstruction in 15 cases
(68%). Of the 32 episodes of complete obstruction, 26 (81%) were initially
managed conservatively; in only one case (3.8%) did obstruction resolve.
Surgery successfully relieved the obstruction in 16 (76%) of 21 patients.
Twenty-six patients received parenteral nutrition at home as the major
treatment for obstruction; 22 (85%) experienced relief of nausea and
vomiting. Patients with malignant obstructions survived 0 to 24 months
(median, 4.7 months); the median survival for those treated surgically was
5.0 months. CONCLUSIONS: In patients with a history of cancer, partial
obstruction (but not complete obstruction) frequently resolves with medical
management. Surgical intervention relieves most cases of partial or
complete obstruction regardless of benign or malignant cause, but survival
often is limited in the latter group. The entire intestinal tract should be
evaluated in all patients, since 8.2% of patients in this series had
concurrent small- and large-bowel obstructions. Home parenteral nutrition
often provides symptomatic palliation in patients not amenable to surgical
relief.
