Abstract
Malignant bowel obstruction (MBO) is a challenging complication of advanced cancer. Several pathophysiologic mechanisms are responsible for the syndrome, including mechanical compression, motility disorders, gastrointestinal secretion accumulation, decreased gastrointestinal absorption, and inflammation. The treatment of related symptoms requires a collaborative approach of surgical, interventional, and medical specialists. The surgical approach proves beneficial in selected patients with operable lesions, life expectancy greater than 2 months, and good performance status. Interventionalists place self-expanding metallic stents as a minimally invasive palliative method either as a definitive treatment or as a bridge to surgery. However, most patients with MBO are not candidates for surgery or stent placement. Medical management with opioids, antispasmodics, anti-emetics, antisecretory agents, and corticosteroids is effective in controlling the symptoms associated with MBO. This article discusses the current understanding of MBO pathophysiology and emphasizes current MBO management concepts; it then reviews surgical, interventional, and medical approaches.
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References and Recommended Reading
Dvoretsky PM, Richards KA, Angel C, et al.: Distribution of disease at autopsy in 100 women with ovarian cancer. Hum Pathol 1988, 19:57–63.
Ripamonti C, De Conno F, Ventafridda V, et al.: Management of bowel obstruction in advanced and terminal cancer patients. Ann Oncol 1993, 4:15–21.
Feuer DJ, Broadley KE, Shepherd JH, Barton DPJ: Systematic review of surgery in malignant bowel obstruction in advanced gynecological and gastrointestinal cancer. Gynecol Oncol 2000, 75:313–322.
Baines M, Oliver DJ, Carter RL: Medical management of intestinal obstruction in patients with advanced malignant disease: a clinical and pathological study. Lancet 1985, 24:1–24.
Baines MJ: The pathophysiology and management of malignant intestinal obstruction. In Oxford Textbook of Palliative Medicine. Edited by Doyle D, Hanks GWC, MacDonald N. Oxford: Oxford University Press; 1998:526–534.
Ripamonti CI, Easson AM, Gerdes H: Management of malignant bowel obstruction. Eur J Cancer 2008, 44:1105–1115.
Feuer DJ, Broadley KE, Shepherd JH, Barton DP: Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev 2000, CD002764.
Ripamonti C, Panzeri C, Groff L, et al.: The role of somatostatin and octreotide in bowel obstruction: pre-clinical and clinical results. Tumori 2001, 87:1–9.
Ventafridda V, Ripamonti C, Caraceni A, et al.: The management of inoperable gastrointestinal obstruction in terminal cancer patients. Tumori 1990, 76:389–392.
Ripamonti C. Management of bowel obstruction in advanced cancer. Curr Opin Oncol 1994, 6:351–357.
Castaldo TW, Petrilli ES, Ballon SC, Lagasse LD: Intestinal operations in patients with ovarian carcinoma. Am J Obstet Gynecol 1981, 139:80–84.
Mangili G, Aletti G, Frigerio L, et al.: Palliative care for intestinal obstruction in recurrent ovarian cancer: a multivariate analysis. Int J Gynecol Cancer 2005, 15:830–835.
Ripamonti C, Twycross R, Baines M, et al.: Clinical-practice recommendations for the management of bowel obstruction in patients with end-stage cancer. Support Care Cancer 2001, 19:23–34.
Ripamonti C: Bowel obstruction. In Textbook of Palliative Medicine. Edited by Bruera E, Higginson I, Ripamonti C, Von Gunten C. New York: Oxford University Press; 2006:587–600.
Cunningham MJ, Bromberg C, Kredenster DC, et al.: Percutaneous gastrostomy for decompression in patients with advanced gynecologic malignancies. Gynecol Oncol 1995, 59:273–276.
Callahan CM, Haag KM, Winberger M, et al.: Outcomes of percutaneous endoscopic gastrostomy among older adults in a community setting. J Am Geriatr Soc 2000, 48:1048–1054.
Vakil N, Morris AI, Marcon N, et al.: A prospective, randomized, controlled trial of covered expandable metal stents in the palliation of malignant esophageal obstruction at the gastroesophageal junction. Am J Gastroenterol 2001, 96:1791–1796.
Gupta K, Freeman M: Enteral and colonic self-expanding metallic stents. Rev Gastroenterol Disord 2008, 8:83–97.
Sebastian S, Johnston S, Geoghegan T, et al.: Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 2004, 99:2051–2057.
Van Hooft JE, Fockens P, Marinelli AW, et al.: Premature closure of the Dutch stent-in I study. Lancet 2006, 368:1573–1574.
Nugent KP, Daniels P, Stewart B, et al.: Quality of life in stoma patients. Dis Colon Rectum 1999, 42:1569–1574.
Smothers L, Hynan L, Fleming J, et al.: Emergency surgery for colon carcinoma. Dis Colon Rectum 2003, 46:24–30.
Law WL, Choi HK, Chue KW: Comparison of stenting with emergency surgery as palliative treatment for obstructing primary left-sided colorectal cancer. Br J Surg 2003, 90:1429–1433.
Leitman IM, Sullivan JD, Brams D, DeCossee JJ: Multivariate analysis of morbidity and mortality from the initial surgical management of obstructing carcinoma of the colon. Surg Gynecol Obstet 1992, 174:513–518.
Martinez-Santos C, Lobato RF, Fradejas JM, et al.: Self-expandable stent before elective surgery vs. emergency surgery for treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates. Dis Colon Rectum 2002, 45:401–406.
Saida Y, Sumiyama Y, Nagao J, Uramatsu M: Long-term prognosis of preoperative “bridge to surgery” expandable metallic stent insertion for obstructive colorectal cancer: comparison with emergency operation. Dis Colon Rectum 2003, 46:S44–S49.
Van Hooft JE, Bemelman WA, Breumelhof R, et al.: Colonic stenting as bridge to surgery versus emergency surgery for management of acute left-sided malignant colonic obstruction: a multicenter randomized trial (Stent-in 2 study). BMC Surg 2007, 7:12.
Johnson E, Thune A, Liedman B: Palliation of malignant gastroduodenal obstruction with open surgical bypass or endoscopic stenting: clinical outcome and health economic evaluation. World J Surg 2004, 28:812–817.
Yim HB, Jacobson BC, Saltzman JR, et al.: Clinical outcome of the use of enteral stents for palliation of patients with malignant upper GI obstruction. Gastrointest Endosc 2001, 53:329–332.
Siddiqui A, Khandelwal N, Anthony T, Huerta S: Colonic stent versus surgery for the management of acute malignant colonic obstruction: a decision analysis. Aliment Pharmacol Ther 2007, 26:1379–1386.
Baines MJ: Nausea, vomiting, and intestinal obstruction. In ABC of Palliative Care. Edited by Fallon M, O’Neill B. London: BMJ Books; 1998:16–18.
Bruera E: Subcutaneous administration of opioids in the management of cancer pain. In: Advances in Pain Research and Therapy, vol 16. Edited by Foley K, Ventafridda V. New York: Raven Press; 1990:203.
Muir CJ, von Gunten CF: Antisecretory agents in gastrointestinal obstruction. Clin Geriatr Med 2000, 16:327–334.
Ripamonti C, Mercadante S: How to use octreotide for malignant bowel obstruction. J Support Oncol 2004, 2:357–364.
Petrelli NJ, Rodriguez-Bigas M, Rustum Y, et al.: Bowel rest, intravenous hydration, and continuous high-dose infusion of octreotide acetate for the treatment of chemotherapy-induced diarrhea in patients with colorectal carcinoma. Cancer 1993, 72:1543–1546.
Shima Y, Ohtsu A, Shirao K, Sasaki Y: Clinical efficacy and safety of octreotide (SMS201-995) in terminally ill Japanese cancer patients with malignant bowel obstruction. Jpn J Clin Oncol 2008, 38:354–359.
Ripamonti C, Mercadante S, Groff L, et al.: Role of octreotide, scopolamine butylbromide, and hydration in symptom control of patients with inoperable bowel obstruction and nasogastric tubes: a prospective, randomized clinical trial. J Pain Symptom Manage 2000, 19:23–34.
Sun X, Li X, Li H: Management of intestinal obstruction in advanced ovarian cancer: an analysis of 57 cases [in Chinese]. Zhonghua Zhong Liu Za Zhi 1995, 17:39–42.
Allen GS: Nausea and vomiting. In Oxford Textbook of Palliative Medicine. Edited by Doyle D, Hanks GWC, MacDonald N. Oxford: Oxford University Press; 1993:282–290.
Twycross R: Corticosteroids. In Pain Relief in Advanced Cancer. Edited by Twycross R. Edinburgh: Churchill Livingston; 1994:425–453.
Ripamonti C: Malignant bowel obstruction in advanced and terminal cancer patients. Eur J Palliat Care 1994, 1:16–19.
Hardy J, Ling J, Mansi J, et al.: Pitfalls in placebo controlled trials in palliative care: dexamethasone for the palliation of malignant bowel obstruction. Palliat Med 1998, 12:437–442.
Feuer DJ, Broadley KE: Corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev 2000:CD001219.
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Roeland, E., von Gunten, C.F. Current concepts in malignant bowel obstruction management. Curr Oncol Rep 11, 298–303 (2009). https://doi.org/10.1007/s11912-009-0042-2
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DOI: https://doi.org/10.1007/s11912-009-0042-2