Surgical Management of Bowel Obstruction in Elderly Patients with Ovarian Cancer Does Not Indicate Survival Benefit

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(ChemotherapyAdvisor) – For the approximately one in five women with advanced ovarian cancer who develop bowel obstruction, median survival is poor and, unless the obstruction is adhesive in origin, the focus should be on optimizing patient comfort rather than increasing survival, a large-scale, population-based assessment reported in Gynecologic Oncology online on December 26, 2012.

Stephen J. Mooney, a doctoral candidate in the Department of Epidemiology at the Mailman School of Public Health, Columbia University, New York, NY, and colleagues identified a cohort of 8,607 women with stages IC-IV ovarian cancer older than 65 in the Surveillance Epidemiology and End Results (SEER)-Medicare database diagnosed between January 1, 1991, and December 31, 2005; 6,966 (80.9%) had died at time of last follow-up.

Subsequent to their diagnosis, 1,518 women (17.6%) were hospitalized for bowel obstruction between cancer diagnosis and end of follow-up, including 1,357 (19.5%) who had died. Among these, 982 (64.7%) were hospitalized once for obstruction; 340 (22.4%) were hospitalized twice; and 196 (13.0%) more than twice. “In the group with any obstructions, the first postdiagnosis obstruction occurred a median of 477 (interquartile range, 224–901) days after cancer diagnosis,” Mooney noted.

“Obstruction at cancer diagnosis (HR 2.17; 95% CI: 1.86-2.52) and mucinous tumor histology (HR 1.45; 95% CI: 1.15-1.83) were associated with increased risk of subsequent obstruction,” they reported, while surgery for obstruction was more common among younger patients, and those with low nodal stage, poorly differentiated tumors, or “ever-adhesive” status. Surgery for obstruction was not associated with tumor histology or history of chemotherapy.

Although obstructions in women managed surgically was associated with a 13.4% mortality rate at 30 days versus a 20.2% mortality rate for those managed nonsurgically, survival and rates of post-obstruction chemotherapy were equivalent after 30 days.

“Median post-obstruction survival was 382 days in women with obstructions of adhesive origin and 93 days in others,” Mooney noted.

Although no formal treatment guidelines currently exist, “it is generally agreed that patients with poor prognostic status are unlikely to benefit from palliative surgery,” they concluded, adding that, “surgical management of obstruction was not associated with improved survival, nor was it associated with fewer hospital visits or a greater proportion of life outside of the hospital after obstruction.”

Abstract

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