Management of bowel obstruction in patients with stage IV cancer: predictors of outcome after surgery
| Autor: | Valerie Francescutti, Austin Miller, Amy Alvarez-Perez, Kelli Bullard Dunn, Yashodhara Satchidanand |
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| Rok vydání: | 2012 |
| Předmět: |
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medicine.medical_specialty Palliative care medicine.medical_treatment Endoscopy Gastrointestinal Article Postoperative Complications Surgical oncology Risk Factors Percutaneous endoscopic gastrostomy Neoplasms Medicine Humans Survival rate Neoplasm Staging Retrospective Studies medicine.diagnostic_test business.industry Palliative Care Cancer Disease Management Retrospective cohort study medicine.disease Prognosis Endoscopy Surgery Bowel obstruction Survival Rate Oncology Female Morbidity business Intestinal Obstruction Follow-Up Studies |
| Zdroj: | Annals of surgical oncology. 20(3) |
| ISSN: | 1534-4681 |
| Popis: | Patients with stage IV cancer and bowel obstruction (BO) present a complicated management problem. We sought to determine if specific parameters could predict outcome after surgery.Records of patients with stage IV cancer and BO treated from 1991 to 2008 were reviewed. For surgical patients, 30-day morbidity and 90-day mortality were assessed using exact multivariable logistic regression methods.Of 198 patients, 132 (66.7%) underwent surgery, 66 medical treatment alone, and demographics were similar. A total of 41 patients (20.7%) were diagnosed with stage IV cancer and BO synchronously, all treated surgically; the remaining presented metachronously. Medically managed patients were more likely to have received chemotherapy in the 30 days prior to BO (45 of 66 [68.2%] vs 40 of 132 [30.3%], p.01). In the surgical group, 30-day morbidity was 35.6%, while 90-day mortality was 42.3%. Median overall survival for synchronous patients was 14.1 months (95% confidence interval [95% CI] 7.6-23.2), and 3.7 months (95% CI 2.5-5.2) and 3.6 months (95% CI 1.5-5.2) for metachronous patients treated surgically and medically, respectively. A multivariate model for 90-day surgical mortality identified low serum albumin, metachronous presentation, and ECOG1 as predictors of death (p.05). A model for 30-day surgical morbidity yielded low hematocrit as a predictive factor (p.05).This cohort identifies characteristics indicative of morbidity and mortality in stage IV cancer and BO. Low serum albumin, ECOG1, and metachronous presentation predicted for 90-day surgical mortality. These data suggest factors that can be used to frame treatment discussion plans with patients. |
| Databáze: | OpenAIRE |
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