Medical Versus Surgical/Endoscopic Management of Malignant Bowel Obstruction in Patients With End-Stage Gynecologic...

Malignant bowel obstruction (MBO) is among the most challenging aspects of late-stage gynecologic cancer care. Surgical/endoscopic interventions carry high complication risks in patients with carcinomatous peritonitis and cachexia. This study examines the impact of surgical/endoscopic interventions on survival time in patients with gynecologic cancer.

We conducted a 12-year retrospective chart review (2013-2024) of all patients with MBO associated with cervical, endometrial, or ovarian cancer who received their initial treatment at our institutions. This MBO cohort was divided into two treatment groups: (i) medical management alone (nasogastric tube, long intestinal tube, octreotide) and (ii) surgical/endoscopic management (percutaneous endoscopic gastrostomy, metallic stent, bypass surgery, stoma formation). The primary outcome measure was 90-day survival from MBO onset; secondary outcome measures included the proportion of patients who, after MBO treatment, recovered oral intake and were discharged home. We compared survival times using Kaplan-Meier analyses and log-rank tests, and analyzed categorical data using the chi-square and Fisher's exact tests. Variables affecting survival time were assessed using the Cox proportional hazards model.

A total of 45 cases of MBO were identified among 1,085 gynecologic cancer patients (4.1%). Of these, 95.5% (43/45) underwent some form of medical management. Of these 43 patients, 16 underwent surgical/endoscopic management. The proportion of patients who regained oral intake and were discharged home after MBO treatment was significantly higher in the surgical/endoscopic group (p < 0.001 for both outcomes). In multivariate analysis, surgical/endoscopic treatment was associated with more prolonged survival (hazard ratio (HR) 0.280; 95%CI 0.104-0.754, p = 0.012), whereas ascites severity was associated with shorter survival (HR 2.252; 95%CI 1.015-4.998, p = 0.046).

At the end-of-life care for patients with late-stage gynecologic cancer and MBO, we found that surgical/endoscopic intervention better enabled resumption of oral intake and discharge to home without affecting survival time.