Mirensky et al evaluated outcomes of women with small bowel obstruction (SBO) and a history of gynecologic cancer. This can help to identify a patient who may benefit from more aggressive management versus palliative care. The authors are from Yale University.
Patient selection: woman with small bowel obstruction and history of gynecologic malignancy
Outcome: overall survival
Predictors of malignant obstruction:
(1) ovarian cancer
(2) advanced stage cancer (Stage III or IV)
(3) early onset obstruction (short time between cancer diagnosis and obstruction)
where:
• The median time interval for all types of cancers was 24 months (2 years) while the average time ranged from 34 to 73.
• The time constituting early onset obstruction was not defined. Optional cutoffs are 12, 18 and 24 months.
Predictors of benign obstruction:
(1) chemotherapy given
(2) radiation therapy given
Predictors of in-hospital mortality if surgery performed:
(1) advanced stage malignancy
(2) absence of abdominal pain at presentation
(3) nasogastric decompression (odds ratio only 1.3)
Predictors of poor survival:
(1) ovarian cancer
(2) malignant small bowel obstruction
(3) gastrostomy tube insertion only (operative management favorable)
(4) anemia
(5) renal impairment with elevated serum creatinine
The average survival with malignant SBO was 9 months. Palliative care may be appropriate for a patient with multiple predictors of poor survival.
