Outcome of palliative operations for malignant bowel obstruction in patients with peritoneal carcinomatosis from nongynecological cancer

Background: Malignant bowel obstruction (MBO) secondary to peritoneal carci nomatosis carries a gave prognosis. We evaluated clinicopathologic factors that predict outcomes after palliative operations for MBO. Methods: Data on patients undergoing laparotomy for palliation of gastroint estinal MBO at City of Hope between 1995 and 2000 were retrospectively coll ected. Successful palliation was defined as the ability to tolerate solid f ood (TSF). Results-Sixty-three patients underwent operative treatment. In 20 patients, MBO was the first presentation of disease; for others, the median disease- free interval was 15 months. The complication rate was 44%, and postoperati ve mortality was 15%. The median length of stay was 12 days. Twenty-nine pa tients. (45%) were discharged from the hospital on a regular diet; 22 (76%) continued to eat until their last follow-up. Median survival was 90 days. Univariate factors for longer survival were TSF on discharge, colorectal pr imary, and nonmetastatic status at first diagnosis. Patients with ascites a nd whose cancer first presented with MBO had an inferior survival, Noncolor ectal primary remained a multivariate predictor for decreased survival. TSF was predicted by the absence of ascites, an obstruction not involving the small bowel, and a preoperative albumin of >3.0 mg/dl. Multiple logistic re gression analysis yielded presence of ascites and small-bowel obstruction a s predictors of inability to TSF. Conclusions: Only one third of patients with MBO from peritoneal carcinomat osis will have prolonged postoperative palliation with significant, but acc eptable, treatment-related morbidity. TSF at discharge is a useful predicto r of continued palliation for most patients. Patients with colorectal cance r may have superior survival outcome and better palliation; others are at r isk for poor outcomes, especially in the presence of ascites and MBO of sma ll bowel. In these patients, highly selective use of laparotomy is recommen ded.