BACKGROUND: Features predictive of malignant small bowel obstructions among patients with previous gynecologic malignancies remain undetermined. METHODS: Predictors of malignancy and mortality among patients with gynecologic malignancies and bowel obstructions were identified through a retrospective review of records. RESULTS: Malignancy was noted among 69.8% of 189 patients included in the analysis. Advanced-stage cancer (P = .006, odds ratio [OR] = 6.62), ovarian malignancy (P = .001, OR = 25.64), and early-onset obstruction (P = .014) predicted malignant etiology, whereas chemotherapy (P < .001, OR = .02) or radiation therapy (P = .027, OR = .09) predicted benign obstruction. The average survival was 9 months versus 49 months for malignant and benign obstructions, respectively. Ovarian cancer (P = .009, hazard ratio [HR] = 4.45), anemia (P = .001, HR = 1.11), and renal dysfunction (P < .001, HR 1.81) impaired survival. CONCLUSIONS: Palliative care should be considered for patients with advanced-stage cancer, ovarian malignancy, and a shorter time interval between cancer diagnosis and bowel obstruction, especially in the setting of anemia and renal dysfunction.
BACKGROUND: Features predictive of malignant small bowel obstructions among patients with previous gynecologic malignancies remain undetermined. METHODS: Predictors of malignancy and mortality among patients with gynecologic malignancies and bowel obstructions were identified through a retrospective review of records. RESULTS:Malignancy was noted among 69.8% of 189 patients included in the analysis. Advanced-stage cancer (P = .006, odds ratio [OR] = 6.62), ovarian malignancy (P = .001, OR = 25.64), and early-onset obstruction (P = .014) predicted malignant etiology, whereas chemotherapy (P < .001, OR = .02) or radiation therapy (P = .027, OR = .09) predicted benign obstruction. The average survival was 9 months versus 49 months for malignant and benign obstructions, respectively. Ovarian cancer (P = .009, hazard ratio [HR] = 4.45), anemia (P = .001, HR = 1.11), and renal dysfunction (P < .001, HR 1.81) impaired survival. CONCLUSIONS: Palliative care should be considered for patients with advanced-stage cancer, ovarian malignancy, and a shorter time interval between cancer diagnosis and bowel obstruction, especially in the setting of anemia and renal dysfunction.
Authors: Jon C Henry; Severin Pouly; Rachael Sullivan; Suhail Sharif; Dori Klemanski; Sherif Abdel-Misih; Nicole Arradaza; David Jarjoura; Carl Schmidt; Mark Bloomston Journal: Surgery Date: 2012-08-26 Impact factor: 3.982