Possible role of palliative surgery for bowel obstruction in advanced ovarian cancer patients

Objectives: Bowel obstruction is a relatively common event (30-40%) in advanced or recurrent ovarian cancer patients. No definitive data are available on the optimal management of this serious complication and treatment is generally limited to adoption of palliative measures. These modalities include both surgical and medical procedures. The aim of this study was to define selection criteria for subjects who would benefit from palliative surgery. Study design: Out of 270 epithelial ovarian cancer patients treated in the period 1984-2005, 75 (28%) developed bowel obstruction related to progression/recurrence of the disease. Palliative treatment - both medical and surgical - was applied on an individual basis. A new score developed by these authors was retrospectivelly applied to this group of patients with the aim of defining a subgroup that could benefit from surgical treatment. Results: Fifty cases (66.7%) were medically treated whereas 25 patients (33.3%) underwent surgery. Mean and median survival rates were 34 and 28 weeks in the surgical group versus 12 and four weeks in the medical group. Distribution according to score showed 53 cases (71%) in the low score group (p< 14) and 22 (29%) in the high score group (p> 14). A significantly better survival was observed in the low-score group (p < 0.0001) and in the surgically treated patients (p < 0.001). According to the risk score variables patients treated surgically for obstruction with low scores had a longer survival (p < 0.005) compared to medical treatment but this difference was not found in the high-risk group (p < 0.05). Conclusions: The prognosis of patients with bowel obstruction in relation to advanced ovarian cancer is best determined by comprehensive assessment of all prognostic parameters to define a subgroup of patients in a low-risk group that may benefit from surgical treatment.

Ovarian cancer; Palliative surgery; Prognostic factors.

[1] Bais J.M.J., Schilthuis M.S., Slors J.F.M., Lammes F.B.: “Intestinal obstruction in patients with advanced ovarian cancer”. Int. J. Gynecol. Cancer,1995, 5,346.

[2] Gadducci A., Iacconi P., Fanucchi A., Cosio S., Miccoli P., Genazzani A.R.: “Survival after intestinal obstruction in patients with fatal ovarian cancer: analysis of prognostic variables”. Int. J. Gynecol. Cancer,1998, 8 (3).

[3] Malone J.M., Koonce T., Larson D.M., Freedman R.S., Carrasco C.H.O., Saul P.B.: “Palliation of small bowel obstruction by percutaneous gastrostomy in patients with progressive ovarian carcinoma”.Obstet. Gynecol., 1986,68, 431.

[4] Campagnutta F., Cannizzaro R., Gallo A., Zarrelli A., Valentini M., De Cicco M., Scarabelli C.: “Palliative treatment of upper intestinal obstruction by gynaecologic malignancy. The usefulness of percuta-neous endoscopic gastrostomy”. Gynecol. Oncol.,1996,62, 103.

[5] Fernandes J.R., Seymour R.J., Suissa S.: “Bowel obstruction in patients with ovarian cancer: a search for prognostic factors”. A.J. Obstet. Gynecol., 1988, 158, 244.

[6] Jong P., Sturgeon J., Jamieson C.G.: “Benefit of palliative surgery for bowel obstruction in advanced ovarian cancer”.J.C.C., 1995, 38,454.

[7] Piver M.S., Barlow J.J., Lele S.B., Frank A.: “Survival after ovarian cancer induced intestinal obstructio”. Gynecol. Oncol., 1982, 13, 44.

[8] Castaldo T.W., Petrilli E.S., Ballon S.C., Lagasse L.D.: “Intestinal operations in patients with ovarian carcinoma”. Am. J. Obstet. Gynecol., 1981, 139,80.

[9] Clarke-Pearson D.L., Chin N.O., De Long E.R., Rice R., Creasman W. T.: “Surgical management of intestinal obstruction in ovarian cancer. I Clinical features, postoperative complications, and survival”.Gynecol. Oncol., 1987, 26, 11.

[10] Larson J.E., Podczaski E.S., Manetta A., Whitney C.W., Mortel R.: “Bowel obstruction in patients with ovarian carcinoma: analysis of prognostic factors”. Gynecol. Oncol.,1989, 35, 61.

[11] Lund B., Hansen M., Lundvall F., Nielsen N.C., Srensen B.L., Hansen H.H.: “Intestinal obstruction in patients with advanced carcinoma of the ovaries treated with combination chemotherapy”. Surg. Gynecol. Obstet., 1989, 169,213.

[12] Salomon H.J., Atkinson K.H., Coppleson J.V.M., Elliott P.M., Houghton C.R., Tattersall M.H., Green D.: “Bowel complications in the management of ovarian cancer”. Aust N.Z. J. Obstet. Gynecol., 1983, 23, 65.

[13] Tunca J.C., Buchler D.A., Mack E.A., Ruzicka F.F., Crowley J.J., Carr W.F.: “The management of ovarian-cancer-caused bowel obstruction”. Gynecol. Oncol., 1981, 12, 186.

[14] Krebs H.B., Goplerud D.R.: “Surgical management of bowel obstruction in advanced ovarian carcinoma”. Obstet. Gynecol., 1983, 61, 327.

[15] Rubin S.C., Hoskins W.J., Benjamin I., Lewis J.L.: “Palliative surgery for intestinal obstruction in advanced ovarian cancer”. Gynecol. Oncol., 1989, 34, 16.

[16] Redman C.W.E., Shafi M.I., Ambrose M., Lawton F.G., Blackledge G.R.P., Luesley D.M. et al.: “Survival following intestinal obstruction in ovarian cancer”. Eur. J. Surg. Oncol., 1988, 14, 383.

[17] Sartori E., Chiudinelli F., Pasinetti B., Zavagnolo V.: “Palliative care in advanced ovarian cancer patients with bowel obstruction”. Gynecol. Oncol., 2005, 99, s215.