Malignant bowel obstruction in recurrent gynecologic cancers: who will benefit from palliative surgical intervention?

Purpose of Investigation: To define factors that assist in the selection of patients with gynecologic cancer who have malignant bowel obstruction (MBO) for those who are most likely to benefit from palliative bowel surgery. Materials and Methods: Between 2004 and 2014, 11 women who underwent surgery for bowel obstruction after a discharge for the treatment of gynecologic cancer were included. The diagnosis of MBO was confirmed by symptoms and signs of intestinal obstruction along with abdominal X-ray, or a computed tomography (CT) scan. Results: The median age of women was 58 years and the median time to surgery was six days. Colostomy was performed in seven of eleven patients, ileostomy in three, and bowel resection and anastomosis in two. Postoperative oral intake was achieved in ten of eleven cases, with a median period of 77 (range, 27-224) days. The progression free interval (PFI) of the primary cancer was < 6 months in six patients and ≥ 6 months in five. The median duration of post-operative oral intake in patients with PFI of < 6 and ≥ 6 months was 34.5 (range, 0-65), and 120 (range, 89-224) days, respectively (p = 0.0014). The median survival time after surgery in patients with PFI of < 6 and ≥ 6 months was 43 (range, 11-111), and 156 (range 94-253) days, respectively (p = 0.0206). Conclusion: PFI of primary gynecologic cancer is a good indicator that could help select for those patients who would most likely benefit from palliative bowel surgery. Surgery for MBO should be considered for patients without serious contraindications.

Malignant bowel obstruction; Bowel surgery; Gynecologic cancer; Oral intake; Progression free interval

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