A single-centre ten-year retrospective cohort study of malignant small bowel obstruction.
Abstract
ntroduction: Management of malignant small bowel obstruction (mSBO) is challenging. The decision to perform an operation evaluates the perceived chance of success against a patient's fitness for operation. The aim of this study was to characterise the mSBO patient population in a tertiary UK centre and assess the patient's treatment pathway including use and effects of palliative surgery, total parenteral nutrition (TPN), Gastrografin and dexamethasone as well as preoperative stratification. Methods: Patients were included if they had mSBO confirmed on computed tomography imaging due to a primary or metastatic neoplasm. Data were collected on pathway and management, and Cox proportional hazard methods were utilised to observe effects on survival. Results: Ninety-four patients were included, with 104 inpatient episodes. Mean age was 67.4 (SD 13.7), with 57 (60.6%) females. Most (89.4%) had only one admission for mSBO. Eighty-four (89.4%) patients died over the ten-year period, 18 (17.3%) within 30 days of admission. Fifty patients (53.1%) underwent operative management: 70% bypass, 24% stoma formation and 6% open-close laparotomies. Log rank testing of survival probability analysis was significant (p = 0.00018), with 50% survival probability at 107.32 days for operative management and 47.87 days for non-operative. Discussion and conclusion: Operative management forms part of the treatment pathway for a significant proportion of patients with mSBO, offering a survival benefit, though quality of survival is not known. Case selection is good, with few open-close laparotomies. Trials of non-operative interventions such as Gastrografin and dexamethasone are not utilised fully.Citation
Cato LD, Evans T, Ward ST. A single-centre ten-year retrospective cohort study of malignant small bowel obstruction. Ann R Coll Surg Engl. 2021 Nov;103(10):738-744. doi: 10.1308/rcsann.2021.0044. Epub 2021 Aug 26Type
ArticleAdditional Links
http://publishing.rcseng.ac.uk/journal/annPMID
34436951Publisher
Royal College of Surgeons of Englandae974a485f413a2113503eed53cd6c53
10.1308/rcsann.2021.0044