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Estudio primario

No clasificado

Bowel obstruction in elderly ovarian cancer patients: a population-based study.

Revista Gynecologic oncology
Año 2013
Enlaces Pubmed DOI PubMed Central

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PURPOSE: Bowel obstruction is a common pre-terminal event in abdominal/pelvic cancer that has mainly been described in small single-institution studies. We used a large, population-based database to investigate the incidence, management, and outcomes of obstruction in ovarian cancer patients. PATIENTS AND METHODS: We identified patients with stages IC-IV ovarian cancer, aged 65 years or older, in the Surveillance, Epidemiology and End Results (SEER)-Medicare database diagnosed between January 1, 1991 and December 31, 2005. We modeled predictors of inpatient hospitalization for bowel obstruction after cancer diagnosis, categorized management of obstruction, and analyzed the associations between treatment for obstruction and outcomes. RESULTS: Of 8607 women with ovarian cancer, 1518 (17.6%) were hospitalized for obstruction subsequent to cancer diagnosis. Obstruction at cancer diagnosis (HR=2.17, 95%CI: 1.86-2.52) and mucinous tumor histology (HR=1.45, 95%CI: 1.15-1.83) were associated with increased risk of subsequent obstruction. Surgical management of obstruction was associated with lower 30-day mortality (13.4% in women managed surgically vs. 20.2% in women managed non-surgically), but equivalent survival after 30 days and equivalent rates of post-obstruction chemotherapy. Median post-obstruction survival was 382 days in women with obstructions of adhesive origin and 93 days in others. CONCLUSION: In this large-scale, population-based assessment of patients with advanced ovarian cancer, nearly 20% of women developed bowel obstruction after cancer diagnosis. While obstruction due to adhesions did not signal the end of life, all other obstructions were pre-terminal events for the majority of patients regardless of treatment.

Estudio primario

No clasificado

Management and outcomes of bowel obstruction in patients with stage IV colon cancer: a population-based cohort study.

Revista Diseases of the colon and rectum
Año 2013
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BACKGROUND: Bowel obstruction is a common complication of late-stage abdominal cancer, especially colon cancer, which has been investigated predominantly in small, single-institution studies. OBJECTIVE: We used a large, population-based data set to explore the surgical treatment of bowel obstruction and its outcomes after hospitalization for obstruction among patients with stage IV colon cancer. DESIGN: This was a retrospective cohort study. SETTING AND PATIENTS: We identified 1004 patients aged 65 years or older in the Surveillance, Epidemiology and End Results-Medicare database diagnosed with stage IV colon cancer January 1, 1991 to December 31, 2005, who were later hospitalized for bowel obstruction. MAIN OUTCOME MEASURES: We describe outcomes after hospitalization and analyzed the associations between surgical treatment of obstruction and outcomes. RESULTS: Hospitalization for bowel obstruction occurred a median of 7.4 months after colon cancer diagnosis, and median survival after obstruction was approximately 2.5 months. Median hospitalization for obstruction was about 1 week and in-hospital mortality was 12.7%. Between discharge and death, 25% of patients were readmitted to the hospital at least once for obstruction, and, on average, patients lived 5 days out of the hospital for every day in the hospital between obstruction diagnosis and death. Survival was 3 times longer in those whose obstruction claims suggested an adhesive obstruction origin. In multivariable models, surgical compared with nonsurgical management was not associated with prolonged survival (p = 0.134). LIMITATIONS: Use of an administrative database did not allow determination of quality of life or relief of obstruction as an outcome, nor could nonsurgical interventions, eg, endoscopic stenting or octreotide, be assessed. CONCLUSIONS: In this population-based study of patients with stage IV colon cancer who had bowel obstruction, overall survival following obstruction was poor irrespective of treatment. Universally poor outcomes suggest that a diagnosis of obstruction in the setting of advanced colon cancer should be considered a preterminal event.

Estudio primario

No clasificado

Palliative management for patients with subacute obstruction and stage IV unresectable rectosigmoid cancer: colostomy versus endoscopic stenting: final results of a prospective randomized trial.

Revista American journal of surgery
Año 2012
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BACKGROUND: Survival in patients with stage IV unresectable rectosigmoid cancer is significantly reduced, and when patients are seen with symptoms of obstruction, it is advisable to perform a diverting colostomy before acute obstruction occurs. The aim of this study was to compare the results of endoscopic stent placement with diverting proximal colostomy in patients with stage IV rectosigmoid cancer and symptoms of chronic subacute obstruction. METHODS: In a prospective randomized trial, 22 patients with stage IV unresectable rectosigmoid cancer and symptoms of chronic subacute obstruction were randomized to either endoscopic placement of an expandable stent or diverting proximal colostomy. Patients were followed until death. RESULTS: There was no case of mortality or major postoperative complications. Oral feeding and bowel function were restored within 24 hours after endoscopic stent placement and within 72 hours after diverting colostomy. Hospital stays were shorter (mean, 2.6 days) in patients with endoscopic stent placement than in those with diverting stomas (mean, 8.1 days) (P < .05). Mean long-term survival was 297 days (range, 125-612 days) in patients who had stents and 280 days (range, 135-591 days) in patients with stomas (P = NS). No case of mortality during follow-up was related to the procedures. All patients with stomas found them quite unacceptable. The same feelings were present in family members. None of the patients with stents or their family members found any inconvenience about the procedure. CONCLUSIONS: Endoscopic expandable stent placement offers a valid solution in patients with stage IV unresectable cancer and symptoms of chronic subacute obstruction, with shorter hospital stays. The procedure is much better accepted, psychologically and practically, by patients and their family members.

Estudio primario

No clasificado

Resultados del tratamiento quirúrgico de la obstrucción intestinal en el cáncer epitelial de ovario en recaída (EOC).

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Revista Gynecologic oncology
Año 2012
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OBJETIVO: Describir los resultados del tratamiento quirúrgico de la obstrucción intestinal en el cáncer epitelial de ovario en recaída (EOC) para definir los criterios de selección de pacientes para la cirugía paliativa. Métodos: 90 mujeres con CEO recaída fueron sometidos a cirugía paliativa por obstrucción intestinal entre 1992 y 2008. RESULTADOS: La edad promedio al momento de la cirugía para la obstrucción intestinal fue de 57 años (rango, 26-85 años). Todos los pacientes habían recibido al menos una línea de quimioterapia basada en platino. La mediana de tiempo desde el diagnóstico de la enfermedad primaria de la cirugía que requiere obstrucción intestinal documentada fue de 19,5 meses (rango, 29 días-14 años). La mediana del intervalo de fecha de curso completo de quimioterapia anterior cirugía por obstrucción intestinal fue de 3,8 meses (rango, 5 días-14 años). Ascitis estaba presente en 38/90 (42%). 49/90 (54%) fueron sometidos a cirugía de emergencia por obstrucción intestinal. Las tasas de mortalidad y morbilidad operativos fueron de 18% y 27%, respectivamente. Paliación exitosa, que se define como la ingesta oral adecuada al menos 60 días postoperatorio, se logró en 59/90 (66%). Sólo la ausencia de ascitis fue identificado como un predictor para la paliación exitosa (p = 0,049). La mediana de supervivencia global (SG) fue de 90,5 días (rango: <1 dia-6 años). Citorreducción óptima, intervalo libre de tratamiento (TFI) y electiva versus cirugía de emergencia no predecir la supervivencia o la paliación exitosa de la cirugía para la obstrucción intestinal (p> 0,05). CONCLUSIÓN: La cirugía para la obstrucción intestinal en recaída EOC se asocia con una alta tasa de morbilidad y mortalidad, especialmente en los casos de emergencia en comparación con otros procedimientos ginecológicos oncológicos. La paliación puede lograrse en casi dos tercios de los casos, es igualmente probable en casos electivos y de emergencia, pero es menos probable en aquellos con ascitis.

Estudio primario

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Outcomes of palliative bowel surgery for malignant bowel obstruction in patients with gynecological malignancy.

Revista Oncology letters
Año 2012
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The aim of this study was to evaluate the outcomes of patients with a gynecological malignancy who received palliative care with and without surgical procedures for malignant bowel obstruction (MBO) and to explore prognostic factors to aid the selection of patients who would benefit from palliative surgery. Medical records of patients with MBO due to a gynecological malignancy treated at our institute between 2005 and 2010 were reviewed. Successful palliation following surgery was defined as the ability to tolerate solid food for at least 60 days. Clinical variables were analyzed using Chi-square or Fisher's exact tests. Survival was evaluated using the Kaplan-Meier method and log-rank test. A total of 53 cases were identified; 20 had bowel surgery for MBO as a palliative procedure and 33 did not. Colostomy was performed in 11 (55%) of 20 patients and ileostomy was performed in 7 (35%). The postoperative morbidity was 35% and mortality within 30 days was 5%. Successful palliation following surgery was achieved in 14 (70%) of 20 cases with a median period of 146 days (range, 61-294). Survival following the diagnosis of MBO was longer in cases with surgery than those without (median survival time, 146 versus 69 days; P<0.0001). Although age, presence of ascites, laboratory values and types of prior anticancer therapy were not significantly different, a longer interval from last anticancer therapy to diagnosis of MBO was observed in patients who underwent surgery compared with those who did not (median, 57 versus 30 days; P<0.05), as well as superior performance status. Among the patients with surgery, the interval was also longer in patients with successful palliation compared with those without (median, 83 versus 32 days; P<0.05). The palliative benefit of surgery for MBO in selected patients with gynecological malignancy was observed. The interval from last anticancer therapy to diagnosis of MBO may serve as a prognostic factor when considering surgical intervention.

Estudio primario

No clasificado

Possible role of palliative surgery for bowel obstruction in advanced ovarian cancer patients.

Revista European journal of gynaecological oncology
Año 2010
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OBJECTIVES: Bowel obstruction is a relatively common event (30-40%) in advanced or recurrent ovarian cancer patients. No definitive data are available on the optimal management of this serious complication and treatment is generally limited to adoption of palliative measures. These modalities include both surgical and medical procedures. The aim of this study was to define selection criteria for subjects who would benefit from palliative surgery. STUDY DESIGN: Out of 270 epithelial ovarian cancer patients treated in the period 1984-2005, 75 (28%) developed bowel obstruction related to progression/recurrence of the disease. Palliative treatment - both medical and surgical - was applied on an individual basis. A new score developed by these authors was retrospectivelly applied to this group of patients with the aim of defining a subgroup that could benefit from surgical treatment. RESULTS: Fifty cases (66.7%) were medically treated whereas 25 patients (33.3%) underwent surgery. Mean and median survival rates were 34 and 28 weeks in the surgical group versus 12 and four weeks in the medical group. Distribution according to score showed 53 cases (71%) in the low score group (< 14) and 22 (29%) in the high score group (> 14). A significantly better survival was observed in the low-score group (p < 0.0001) and in the surgically treated patients (p < 0.001). According to the risk score variables patients treated surgically for obstruction with low scores had a longer survival (p < 0.005) compared to medical treatment but this difference was not found in the high-risk group (p < 0.05). CONCLUSIONS: The prognosis of patients with bowel obstruction in relation to advanced ovarian cancer is best determined by comprehensive assessment of all prognostic parameters to define a subgroup of patients in a low-risk group that may benefit from surgical treatment.

Estudio primario

No clasificado

Un análisis de los resultados futuros de procedimientos paliativos realizados por obstrucción intestinal maligna debido al cáncer de ovario recurrente.

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Revista The oncologist
Año 2009
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OBJETIVO: Obtener datos de los resultados futuros en pacientes (pts) sometidos operativo paliativo o procedimientos endoscópicos para la obstrucción intestinal maligna debido al cáncer de ovario recurrente. MÉTODOS: Un estudio institucional se llevó a cabo entre julio de 2002 julio de 2003 al identificar prospectivamente pts que se sometieron a un procedimiento quirúrgico o endoscópico para paliar los síntomas del cáncer avanzado. Este informe se centra en pts con obstrucción intestinal maligna debido al cáncer de ovario recurrente. Los procedimientos realizados con un gastrointestinal superior o inferior (GI) endoscopio se consideraron "endoscópico." Todos los demás casos fueron clasificados como "operativo". Siguiendo el procedimiento, la presencia o ausencia de síntomas se determinó y seguidos en el tiempo. Todos los puntos fueron seguidos hasta la muerte. RESULTADOS: Las intervenciones paliativas se realizaron en 74 pts oncología ginecológica durante el período de estudio, de los cuales 26 (35%) fueron por obstrucción gastrointestinal maligno debido a un cáncer de ovario recurrente. El sitio de la obstrucción del intestino delgado fue de 14 (54%) casos y el intestino grueso en 12 (46%) casos. Procedimientos paliativos estaban operativos en 14 (54%) pts y endoscópica en los otros 12 (46%). En general, la mejoría sintomática o resolución dentro de 30 días se logró en 23 (88%) de 26 pacientes, con 1 (4%) de mortalidad después del procedimiento. A los 60 días, 10 (71%) de los 14 pts que se sometieron a procedimientos quirúrgicos y 6 (50%) de 12 puntos que tenían procedimientos endoscópicos tenido control de los síntomas. La mediana de supervivencia desde el momento del procedimiento paliativo fue 191 días (rango, 33-902) para los sometidos a un procedimiento quirúrgico y 78 días (rango, 18-284) para los sometidos a un procedimiento endoscópico. CONCLUSIÓN: Los pacientes con obstrucciones intestinales malignos debido al cáncer de ovario recurrente tienen una alta probabilidad de experimentar el alivio de los síntomas con procedimientos paliativos. Aunque la recurrencia de los síntomas es común, la paliación duradera y la supervivencia prolongada son posibles, especialmente en aquellos pacientes seleccionados para la intervención quirúrgica.

Estudio primario

No clasificado

Surgery for the palliation of intestinal obstruction in advanced abdominal malignancy.

Autores Wong TH , Tan YM
Revista Singapore medical journal
Año 2009
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INTRODUCTION: Intestinal obstruction commonly occurs in advanced abdominal and pelvic malignancy. Management of these patients is difficult, as it is uncertain which patients benefit from palliative surgery and which benefit from medical management. METHODS: Clinical records for patients who underwent surgery for palliation of bowel obstruction were reviewed retrospectively. All had metastatic malignant disease and were seen by the general surgical department for intestinal obstruction. The following factors were examined: preoperative albumin, APACHE II score, age, site of metastases, presence of ascites, operative findings and type of operative procedure performed, length of postoperative stay and mortality. RESULTS: 27 palliative operations for intestinal obstruction for metastatic malignancy were performed during this period. This included two patients who were re-operated on for recurrence of intestinal obstruction after recovering from the first operation. All patients had radiological evidence of intestinal obstruction preoperatively. All patients who survived were discharged from hospital without requiring parenteral nutrition or hydration, and were able to tolerate oral medication and feeds. In this small series, site of metastases, presence of ascites, APACHE II score and gender were not predictive of mortality. An albumin level of 21 g/L or less was predictive of mortality. Almost 50 percent of these patients would require a stoma. Our series had a 30-day mortality rate of 20 percent. CONCLUSION: Surgery does have a role in palliation of symptoms of intestinal obstruction in carefully selected patients with advanced abdominal and pelvic malignancy. Patients should be counselled on the likelihood of a stoma and the 30-day mortality risk.

Estudio primario

No clasificado

Bowel obstruction and survival in patients with advanced ovarian cancer: analysis of prognostic variables.

Revista International journal of gynecological cancer : official journal of the International Gynecological Cancer Society
Año 2009
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Estudio primario

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La resección de metástasis peritoneales que causan obstrucción maligna del intestino delgado.

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Autores Abbas SM , Merrie AE
Revista World journal of surgical oncology
Año 2007
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ANTECEDENTES: La resección de metástasis peritoneales se ha demostrado mejorar la supervivencia en pacientes con enfermedad metastásica abdominal de malignidad abdominal abdominal o extra. Este estudio evalúa el beneficio de la resección metastásica peritoneal en pacientes con obstrucción del intestino delgado maligno y antecedentes de cáncer tratado. Pacientes y métodos: Los pacientes sometidos a laparotomía para la resección de las metástasis peritoneales de recurrencia de cáncer previo entre 1992-2003 se revisaron retrospectivamente. Se recogieron datos sobre el tipo de cáncer primario, el intervalo de recurrencia, extensión de la enfermedad y la integridad de la resección, la morbilidad y la mortalidad y la supervivencia a largo plazo. RESULTADOS: Entre 1992 y 2003 hubo 79 pacientes (edad media 62, rango 19-91) que tenían una laparotomía por obstrucción del intestino delgado debido a un cáncer recurrente. El cáncer primario era colorrectal (31), cáncer ginecológico (19), melanoma (16) y otros (13). En general, la tasa de complicaciones fue del 35% y la mortalidad fue del 10%. La mediana de supervivencia fue de 5 meses; los pacientes con antecedentes de cáncer colorrectal tienen mejor supervivencia que otro tipo de cáncer (supervivencia mediana 7 meses frente a 4 meses; p = 0,02). El análisis multivariado mostró que la extensión de la enfermedad recurrente fue el único factor que afectó a la supervivencia global. CONCLUSIÓN: La laparotomía por obstrucción del intestino delgado es una opción que vale la pena para los pacientes con obstrucción maligna del intestino delgado. A pesar de que se asocia con una morbilidad y mortalidad significativa que ofrece un beneficio de supervivencia razonable, en particular para los pacientes con enfermedad completamente resecable.