Outcome prognostic factors in inoperable malignant bowel obstruction |
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Authors: | Margarita Romeo Maria de los LLanos Gil José Luís Cuadra Urteaga Laia Vilà Sara Ahlal Alberto Indacochea Núria Pardo Joaquim Radua Albert Font Albert Tuca |
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Affiliation: | 1.Medical Oncology Department,Institut Català d’Oncologia,Badalona,Spain;2.Universitat Autónoma de Barcelona,Barcelona,Spain;3.Center for Genomic Regulation (CRG),Vall d’Hebron Institut de Recerca,Barcelona,Spain;4.Medical Oncology Department, Hospital Vall d’Hebron,Vall d’Hebron Institut of Oncology,Barcelona,Spain;5.FIDMAG Germanes Hospitalàries- CIBERSAM,Sant Boi de Llobregat,Spain;6.Centre for Psychiatry Research, Department of Clinical Neuroscience,Karolinska Institutet,Solna,Sweden;7.Supportive Care in Cancer Unit, Medical Oncology Department,Hospital Clínic de Barcelona,Barcelona,Spain |
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Abstract: | PurposeInoperable malignant bowel obstruction (MBO), a severe complication of peritoneal carcinomatosis, has a low desobstruction rate (30–40 %) and end-of-life decision-making is hampered by the lack of known prognostic factors. This study aimed to explore prognostic factors for desobstruction in MBO.MethodsAll patients with inoperable MBO admitted in our large oncology hospital between 2010 and 2013 were treated following a clinical protocol based on antiemetics, steroids and two antisecretories, octreotide, and hyoscine butylbromide. Two prognostic factor analyses using logistic regressions were performed, one based on data from day 1 of admission and the other on data from day 8.ResultsForty-five patients were included. Frequency of desobstruction was 48.9 %. In the analysis of prognostic factors on day 1, MBO episodes derived from functional physiopathologic mechanisms (vs. mechanic or mixed) were more prone to resolve (p < 0.001 corrected for multiple comparisons). Considering patients alive with persistent obstruction on day 8, a better clinical condition was the variable more associated with desobstruction, but without statistical significance after correction for multiple comparisons.ConclusionsA functional physiopathologic mechanism of MBO development may be an early prognostic factor for desobstruction. A high proportion of desobstruction was observed, suggesting that the combination of antisecretories with different mechanism of action warrants further investigation. |
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