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Original Research

Open Access

Outcomes of palliative surgery for bowel obstruction in end of life ovarian cancer care in a tertiary cancer centre

  • Bernard Kennedy1,*,
  • Kate Sexton1
  • Noreen Gleeson1

1Department of GynaeOncology, St James Hospital, D08 NHY1 Dublin, Ireland

DOI: 10.31083/j.ejgo4206162 Vol.42,Issue 6,December 2021 pp.1112-1115

Submitted: 29 August 2021 Accepted: 14 October 2021

Published: 15 December 2021

*Corresponding Author(s): Bernard Kennedy E-mail: kennedybernard@outlook.com

Abstract

Objective: We studied the demographic of patients with ovarian cancer in end of life care undergoing palliative surgery for bowel obstruction in relation to its success in restoring bowel function and enhancing other aspects of palliative care, including discharge from the acute hospital setting. Methods: Hospital data on all consecutive ovarian cancer patients who underwent palliative surgery for bowel obstruction over five years up to end December 2017 was analysed. Successful palliation was measured by relief of bowel obstruction and discharge from the acute hospital setting. Results: Twenty-eight patients were identified. The mean age at time of surgery was 64.75 years. Histology was high grade serous in the majority (63.5%). Substantial co-morbidites were cardiovascular (10.7%) and respiratory (14.3%) at initial diagnosis. Surgery was performed on average after 13 days of conservative management of bowel obstruction (Standard deviation (SD) 10.6 days). All had some procedure for bowel decompression; 82% (23) required stoma including gastrostomy 10% (3); jejunostomy 3% (1); ileostomy loop 25% (7), double barrel ileostomy 3% (1), end ileostomy 10% (3); colostomy loop 10% (3), end colostomy 14% (4); end ileostomy & loop colostomy 3% (1). No stoma was required in 18% (5). 42.8% (12) had an anastomosis to bypass obstruction and five of these did not require a stoma. Postoperative complications arose in 30%. Sixteen had protracted hospital stay after surgery, 14 for clinical reasons and 2 for social/domestic reasons. Two patients died in the acute hospital following surgery. Median survival following surgery was 84 days. Conclusions: The management of bowel obstruction in end of life care in ovarian cancer is a common and challenging clinical task. Surgery to palliate bowel obstruction was successful in the majority of this cohort of patients with advanced ovarian cancer in end of life care.

Keywords

Ovarian cancer; Bowel obstruction; Palliative surgery

Cite and Share

Bernard Kennedy,Kate Sexton,Noreen Gleeson. Outcomes of palliative surgery for bowel obstruction in end of life ovarian cancer care in a tertiary cancer centre. European Journal of Gynaecological Oncology. 2021. 42(6);1112-1115.

References

[1] NCRI. Measuring cancer cure in Ireland. 2019. Available at: https://www.ncri.ie/sites/ncri/files/pubs/NCRICancerCure report_26022019.pdf (Accessed: 8 October 2021).

[2] Pickel H, Lahousen M, Stettner H, Girardi F. The spread of ovarian cancer. Baillieres Clinical Obstetrics and Gynaecology. 1989; 3: 3–12.

[3] Nieman KM, Kenny HA, Penicka CV, Ladanyi A, Buell-Gutbrod R, Zillhardt MR, et al. Adipocytes promote ovarian cancer metastasis and provide energy for rapid tumor growth. Nature Medicine. 2011; 17: 1498–1503.

[4] Ripamonti CI, Easson AM, Gerdes H. Management of malignant bowel obstruction. European Journal of Cancer. 2008; 44: 1105– 1115.

[5] Teunissen SCCM, Wesker W, Kruitwagen C, de Haes HCJM, Voest EE, de Graeff A. Symptom prevalence in patients with in- curable cancer: a systematic review. Journal of Pain and Symptom Management. 2007; 34: 94–104.

[6] Kucukmetin A, Naik R, Galaal K, Bryant A, Dickinson HO. Pal- liative surgery versus medical management for bowel obstruction in ovarian cancer. Cochrane database Systematic Reviews. 2010; 2010: CD007792.

[7] Pothuri B, Vaidya A, Aghajanian C, Venkatraman E, Barakat RR, Chi DS. Palliative surgery for bowel obstruction in recurrent ovarian cancer: an updated series. Gynecologic Oncology. 2003; 89: 306–313.

[8] Weafer J. Irish attitudes to death, dying and bereavement. 2004– 2014. 2014.

[9] Helyer L, Easson AM. Surgical approaches to malignant bowel obstruction. The Journal of Supportive Oncology. 2008; 6: 105–113.

[10] Roeland E, von Gunten CF. Current concepts in malignant bowel obstruction management. Current Oncology Reports. 2009; 11: 298–303.

[11] Lee YC, Jivraj N, O’Brien C, Chawla T, Shlomovitz E, Buchanan S, et al. Malignant Bowel Obstruction in Advanced Gynecologic Cancers: an Updated Review from a Multidisciplinary Perspective. Obstetrics and Gynecology International. 2018; 2018: 1867238.

[12] Gleeson NC, Hoffman MS, Fiorica JV, Roberts WS, Cavanagh D. Gastrostomy Tubes after Gynecologic Oncologic Surgery. Gynecologic Oncology. 1994; 54: 19–22.

[13] Chappell VL, Thompson MD, Jeschke MG, Chung DH, Thompson JC, Wolf SE. Effects of incremental starvation on gut mucosa. Digestive Diseases and Sciences. 2003; 48: 765–769.

[14] Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jack- son VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. The New England Journal of Medicine. 2010; 363: 733–742.

[15] Hoverman JR, Mann BB, Phu S, Nelson P, Hayes JE, Taniguchi CB, et al. Hospice or Hospital: The Costs of Dying of Cancer in the Oncology Care Model. Palliative Medicine Reports. 2020; 1: 92–96.

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