MANAGEMENT OF BOWEL OBSTRUCTION IN PATIENTS WITH ABDOMINAL CANCER

Objective: To determine the value of operation in patients with bowel obstruction caused by recurrent abdominal cancer. Design: Retrospectiv e case review. Setting: The University of Connecticut Health Center, F armington. Patients: Ninety-eight patients admitted with a diagnosis o f bowel obstruction and malignant neoplasm between November 1, 1987, a nd June 30, 1995. Results: Data for 75 patients who developed a bowel obstruction within 5 years of a malignant diagnosis were analyzed. For ty-six patients (61%) were treated operatively and 29 (39%) were treat ed nonoperatively. The operative group included 32 patients (70%) whos e obstruction was caused by carcinomatosis; 6 (19%) of these 32 patien ts had had at least 1 episode of previous obstruction requiring hospit alization. They had a 22% in-hospital mortality, stayed an average of 21 days in the hospital, and survived 7+/-6 months (mean+/-SD) after d ischarge; 5 (16%) had at least I episode of postoperative obstruction that required hospitalization. After discharge from the hospital, 53% had an excellent or good quality of life (assessed retrospectively). O f the 29 patients in the nonoperative group, 16 (55%) had carcinomatos is. These 16 patients had a 38% in-hospital mortality (6 of 16), staye d an average of 10 days in the hospital, and survived a mean of 13+/-9 months; 3 (19%) had at least 1 episode of recurrent obstruction requi ring hospitalization. After discharge from the hospital, 6 (37%) had a n excellent or good quality of life. Conclusion: The value of operativ e intervention for bowel obstruction in patients with cancer is derive d from the possibility of a benign cause, not alleviation of the conse quences of carcinomatosis.