Systematic review of surgery in malignant bowel obstruction in advanced gynecological and gastrointestinal cancer

Objective. The objective was to locate, appraise, and summarize evidence fr om scientific studies on intestinal obstruction due to advanced gynecologic al and gastrointestinal cancer in order to assess the efficacy of surgery. Materials and methods, Data sources: A comprehensive list of studies was pr ovided by an extensive search of electronic databases, relevant journals, b ibliographic databases, conference proceedings, reference lists, the gray l iterature, personal contact, and the worldwide web, Data synthesis: Two res earchers extracted the data independently, Due to the methodological qualit y of the studies, only a qualitative assessment was possible. Results, The role of surgery in malignant bowel obstruction remains controv ersial, and no firm conclusions from the many retrospective case series can be made. Control of symptoms varies from 42% to over 80%, although it is o ften unclear how symptoms were measured and whether the symptom scores used are validated, There is a large range in the rates of reobstruction, from 10 to 50%, although time to reobstruction was often not included. There is a wide range of postoperative morbidity and mortality, although again the d efinition of both of these surgical outcomes varied among many of the paper s. Conclusion. The role of surgery in malignant bowel obstruction needs carefu l evaluation, using validated outcome measures on symptom control and quali ty of life scores. Further information would include reobstruction rates to gether with the morbidity associated with the various surgical procedures. Currently, bowel obstruction is managed empirically, and there are marked v ariations in clinical practice by different units, There needs to be a grea ter standardization of management so that comparisons between different ser ies can be made. (C) 1999 Academic Press.