Predictors of adverse surgical outcome in the management of malignant bowel obstruction

Malignant bowel obstruction (MBO) is a common problem in patients with advanced colorectal or ovarian cancer. The management of this group of patients is complex and controversial.

To analyze the factors associated with morbidity and mortality in patients who underwent surgery for MBO in a tertiary referral center in Mexico City.

Hospital records of patients who underwent surgery for malignant bowel obstruction from January 1987 through December 2005 were retrospectively analyzed. Demographic data, clinical and surgical variables were recorded. Morbidity and mortality within 30-day of surgical procedure were registered. Factors associated with outcome were analyzed with the chi-square test. Survival curves were constructed with the Kaplan-Meier method.

One-hundred and thirty patients were included. Primary neoplasm was the cause of bowel obstruction in 51 (39.2%) patients. Resection and anastomosis was performed in 45 patients (34.6%); in 30 cases (23.1%) a palliative estoma was constructed. Hospital mortality rate was 10.8%, and major postoperative morbidity was 16.2%. Factors associated with a significant increase in surgical mortality were: advanced patient age 17.2% (p = 0.009), hipoalbuminemia 14.45% (p = 0.027) and surgery performed for neoplasms different from those of gastrointestinal origin 17.6% (p = 0.005). Surgical morbidity was significantly higher in patients with poor performance status 16.2% (p = 0.017), advanced age 18% (p = 0.04), and low albumin levels 13.5% (p = 0.03). Median survival for the entire cohort was nine months (95% CI 5-13). Actuarial one, three and five year survival were 38.4, 27.5 and 25.4%, respectively. The most significant predictor of survival was performance status.

When surgical management of MBO is considered, a careful assessment of the factors shown here to predict an adverse surgical outcome and poor prognosis is required.