Margarita Romeo1,2, Maria de Los LLanos Gil3, José Luís Cuadra Urteaga3, Laia Vilà3, Sara Ahlal3, Alberto Indacochea3,4, Núria Pardo3,5, Joaquim Radua6,7, Albert Font3, Albert Tuca8. 1. Medical Oncology Department, Institut Català d'Oncologia, Carretera del Canyet s/n, 08916, Badalona, Spain. mromeo@iconcologia.net. 2. Universitat Autónoma de Barcelona, Barcelona, Spain. mromeo@iconcologia.net. 3. Medical Oncology Department, Institut Català d'Oncologia, Carretera del Canyet s/n, 08916, Badalona, Spain. 4. Center for Genomic Regulation (CRG), Vall d'Hebron Institut de Recerca, Barcelona, Spain. 5. Medical Oncology Department, Hospital Vall d'Hebron, Vall d'Hebron Institut of Oncology, Barcelona, Spain. 6. FIDMAG Germanes Hospitalàries- CIBERSAM, Sant Boi de Llobregat, Spain. 7. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden. 8. Supportive Care in Cancer Unit, Medical Oncology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
Abstract
PURPOSE: Inoperable malignant bowel obstruction (MBO), a severe complication of peritoneal carcinomatosis, has a low desobstruction rate (30-40 %) and end-of-life decision-making is hampered by the lack of known prognostic factors. This study aimed to explore prognostic factors for desobstruction in MBO. METHODS: All patients with inoperable MBO admitted in our large oncology hospital between 2010 and 2013 were treated following a clinical protocol based on antiemetics, steroids and two antisecretories, octreotide, and hyoscine butylbromide. Two prognostic factor analyses using logistic regressions were performed, one based on data from day 1 of admission and the other on data from day 8. RESULTS: Forty-five patients were included. Frequency of desobstruction was 48.9 %. In the analysis of prognostic factors on day 1, MBO episodes derived from functional physiopathologic mechanisms (vs. mechanic or mixed) were more prone to resolve (p < 0.001 corrected for multiple comparisons). Considering patients alive with persistent obstruction on day 8, a better clinical condition was the variable more associated with desobstruction, but without statistical significance after correction for multiple comparisons. CONCLUSIONS: A functional physiopathologic mechanism of MBO development may be an early prognostic factor for desobstruction. A high proportion of desobstruction was observed, suggesting that the combination of antisecretories with different mechanism of action warrants further investigation.
PURPOSE: Inoperable malignant bowel obstruction (MBO), a severe complication of peritoneal carcinomatosis, has a low desobstruction rate (30-40 %) and end-of-life decision-making is hampered by the lack of known prognostic factors. This study aimed to explore prognostic factors for desobstruction in MBO. METHODS: All patients with inoperable MBO admitted in our large oncology hospital between 2010 and 2013 were treated following a clinical protocol based on antiemetics, steroids and two antisecretories, octreotide, and hyoscine butylbromide. Two prognostic factor analyses using logistic regressions were performed, one based on data from day 1 of admission and the other on data from day 8. RESULTS: Forty-five patients were included. Frequency of desobstruction was 48.9 %. In the analysis of prognostic factors on day 1, MBO episodes derived from functional physiopathologic mechanisms (vs. mechanic or mixed) were more prone to resolve (p < 0.001 corrected for multiple comparisons). Considering patients alive with persistent obstruction on day 8, a better clinical condition was the variable more associated with desobstruction, but without statistical significance after correction for multiple comparisons. CONCLUSIONS: A functional physiopathologic mechanism of MBO development may be an early prognostic factor for desobstruction. A high proportion of desobstruction was observed, suggesting that the combination of antisecretories with different mechanism of action warrants further investigation.