Presurgical Factors Predict Bowel-Obstruction Surgical Mortality Rates Among Patients with Metastatic Cancer
“This large cohort presents sobering data regarding survival in patients with stage IV cancer and BO (bowel obstruction),” reported Valerie Francescutti, MD, of the Department of Surgical Oncology, Roswell Park Cancer Institute, in Buffalo, New York, and coauthors. “In patients with metachronous presentations, survival in those treated surgically or endoscopically versus medically was not different.”
The team reviewed the medical records of 198 patients with stage IV cancer and bowel obstruction treated during 1991 to 2008. Of these, 41 patients (20.7%) were simultaneously diagnosed with stage IV cancer and bowel obstruction; the other patients were diagnosed metachronously, the authors reported.
“A multivariate model for 90-day surgical mortality identified low serum albumin, metachronous presentation, and ECOG > 1 as predictors of death (P<0.05),” they wrote. “A model for 30-day surgical morbidity yielded low hematocrit as a predictive factors (P<0.05).”
These factors “can be used to frame treatment discussion plans with patients,” they noted.
Median overall survival (OS) was 14.1 months (95% CI: 7.6-23.2 months) for synchronously-diagnosed patients and 3.7 months (95% CI: 2.5-5.2) for metachronously-presenting patients treated surgically. (For metachronously-diagnosed patients treated without surgery, OS was 3.6 months (95% CI: 1.5-5.2).
The findings do not “suggest that no patient with stage IV cancer and BO would benefit from a surgical or endoscopic procedure,” the authors noted.