A scoring system for the prognosis and treatment of malignant bowel obstruction

Jon C. Henry, Severin Pouly, Rachael Sullivan, Suhail Sharif, Dori Klemanski, Sherif Abdel-Misih, Nicole Arradaza, David Jarjoura, Carl Schmidt, Mark Bloomston

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33 Scopus citations

Abstract

Background: Malignant bowel obstruction is a common result of end-stage abdominal cancer that is a treatment dilemma for many physicians. Little has been reported predicting outcomes or determining the role of surgical intervention. We sought to review our experience with surgical and nonsurgical management of malignant bowel obstruction to identify predictors of 30-day mortality and of who would most likely benefit from surgical intervention. Methods: A chart review of 523 patients treated between 2000 and 2007 with malignant bowel obstruction were evaluated for factors present at admission to determine return to oral intake, 30-day mortality, and overall survival. Propensity score matching was used to homogenize patients treated with and without surgery to identify those who would benefit most from operative intervention. Results: Radiographic evidence of large bowel obstruction was predictive of return to oral intake. Hypoalbuminemia and radiographic evidence of ascites or carcinomatosis were all predictive of increased 30-day mortality and overall survival. A nomogram of 5 identified risk factors correlated with increased 30-day mortality independent of therapy. Patients with large bowel or partial small bowel obstruction benefited most from surgery. A second nomogram was created from 4 identified risk factors that revealed which patients with complete small bowel obstruction might benefit from surgery. Conclusion: Two nomograms were created that may guide decisions in the care of patients with malignant bowel obstruction. These nomograms are able to predict 30-day mortality and who may benefit from surgery for small bowel obstruction.

Original languageEnglish
Pages (from-to)747-757
Number of pages11
JournalSurgery (United States)
Volume152
Issue number4
DOIs
StatePublished - Oct 2012

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    Henry, J. C., Pouly, S., Sullivan, R., Sharif, S., Klemanski, D., Abdel-Misih, S., Arradaza, N., Jarjoura, D., Schmidt, C., & Bloomston, M. (2012). A scoring system for the prognosis and treatment of malignant bowel obstruction. Surgery (United States), 152(4), 747-757. https://doi.org/10.1016/j.surg.2012.07.009