SMALL-BOWEL OBSTRUCTION IN PATIENTS WITH A PRIOR HISTORY OF CANCER

To assess the efficacy of operative and nonoperative therapy of small bowel obstruction (SBO) in patients with a previous diagnosis of cancer, a review of 54 cases was carried out. The 32 men and 22 women had a mean age of 58 years. At presentation with SBO, 26 patients (48%) had known recurrent cancer. Forty patients were initially treated nonoperatively; 11 (28%) had resolution of their SBO after a mean of 7 days of nasogastric suction. Five of 11 patients developed recurrent SBO prior to death. Thirty-seven patients underwent laparotomy, 14 on the day of admission and 23 after failure of nasogastric suction. Twenty-five of 37 (68%) had obstruction due to recurrent carcinoma. Small bowel obstruction due to recurrent cancer occurred earlier (21 +/- 5 months) than SBO from benign causes (61 +/- 18 months; p < 0.01). Mean survival for patients with malignant obstruction (5 +/- 1 month) was significantly shorter than for those with benign obstruction (50 +/- 10 months; p < 0.001). The 30-day and in-hospital mortality rates for the 25 surgically treated patients with malignant SBO were 24% and 28%, respectively; in 9 of 25 (36%), the obstruction failed to fully resolve. The only factor predictive of in-hospital mortality was obstruction secondary to cancer (p < 0.05). The median posthospital survival for surgically treated patients with malignant SBO was only 2.5 months. We conclude that: (1) patients should be given an initial trial of nonoperative therapy; (2) patients with no known recurrence or a long interval to the development of SBO should be aggressively treated with early surgery if nonoperative treatment fails; and (3) for patients with known abdominal recurrence in whom nonoperative therapy fails, the results of surgical palliation are grim. Innovative approaches are needed to maximize palliation while also limiting morbidity and mortality.