Malignant bowel obstruction related to advanced peritoneal metastases: survival outcomes of surgical treatment

Malignant bowel obstruction (MBO) caused by advanced peritoneal metastases (PM) carries a poor prognosis. Surgical intervention may be the only therapeutic option in selected cases, but operative risks must be carefully balanced against potential benefits. This study aimed to evaluate the outcomes of patients undergoing surgery for MBO secondary to PM.

Single-centre retrospective analysis of consecutive patients operated for MBO of various origins between 2016 and 2021. The primary outcome was overall survival (OS). Secondary outcomes included postoperative morbidity, resumption of systemic chemotherapy, and incidence of re-obstruction.

A total of 27 patients (median age 64 years, 67 % female) were included. Median peritoneal cancer index (PCI) was 32, and ascites was present in 16 patients (59 %). Surgical resolution of obstruction was achieved in 24 patients (88 %) via bowel resection (n=10), internal bypass (n=7), stoma formation (n=5), or adhesiolysis (n=2). Severe morbidity occurred in 26 %, with no postoperative mortality. Five patients (19 %) required reoperation, and three (11 %) developed enterocutaneous fistulae. Median OS was 4.0 months (IQR 9.4). Survival rates at 3, 6, and 12 months were 56 , 37, and 26 %, respectively. Postoperative systemic chemotherapy was resumed in 19 patients (70 %), significantly more often among those surviving >6 months (p=0.02). Re-obstruction occurred in 14 patients (52 %).

Surgery is a feasible and valid therapeutic option for selected patients with MBO due to advanced PM. Despite considerable morbidity, most patients are able to resume systemic chemotherapy, which may contribute to improved survival outcomes.