Surgical intervention for malignant bowel obstruction caused by gastrointestinal malignancies

BACKGROUND Malignant bowel obstruction(MBO)is a common event for end-stage gastrointestinal cancer patients.Previous studies had demonstrated manifestations and clinical management of MBO with mixed malignancies.There still lack reports of the surgical treatment of MBO.AIM To analyze the short-term outcomes and prognosis of palliative surgery for MBO caused by gastrointestinal cancer.METHODS A retrospective chart review of 61 patients received palliative surgery between January 2016 to October 2018 was performed,of which 31 patients underwent massive debulking surgery(MDS)and 30 underwent ostomy/by-pass surgery(OBS).The 60-d symptom palliation rate,30-d morbidity and mortality,and overall survival rates were compared between the two groups.RESULTS The overall symptom palliation rate was 75.4%(46/61);patients in the MDS group had significantly higher symptom palliation rate than OBS group(90%vs 61.2%,P=0.016).Patients with colorectal cancer who were in the MDS group showed significantly higher symptom improvement rates compared to the OBS group(overall,76.4%;MDS,61.5%;OBS,92%;P=0.019).However,patients with gastric cancer did not show a significant difference in symptom palliation rate between the MDS and OBS groups(OBS,60%;MDS,80%;P=1.0).The median survival time in the MDS group was significantly longer than in the OBS group(10.9 mo vs 5.3 mo,P=0.05).CONCLUSION For patients with MBO caused by peritoneal metastatic colorectal cancer,MDS can improve symptom palliation rates and prolong survival,without increasing mortality and morbidity rates.