Surgery for the palliation of intestinal obstruction in advanced abdominal malignancy

ABSTRACT 

Introduction Intestinal obstruction commonly occurs in advanced abdominal and pelvic malignancy. Management of these patients is difficult, as it is uncertain which patients benefit from palliative surgery and which benefit from medical management. 

Methods Clinical records for patients who underwent surgery for palliation of bowel obstruction were reviewed retrospectively. All had metastatic malignant disease and were seen by the general surgical department for intestinal obstruction. The following factors were examined: preoperative albumin, APACHE II score, age, site of metastases, presence of ascites, operative findings and type of operative procedure performed, length of postoperative stay and mortality. 

Results 27 palliative operations for intestinal obstruction for metastatic malignancy were performed during this period. This included two patients who were re-operated on for recurrence of intestinal obstruction after recovering from the first operation. All patients had radiological evidence of intestinal obstruction preoperatively. All patients who survived were discharged from hospital without requiring parenteral nutrition or hydration, and were able to tolerate oral medication and feeds. In this small series, site of metastases, presence of ascites, APACHE II score and gender were not predictive of mortality. An albumin level of 21 g/L or less was predictive of mortality. Almost 50 percent of these patients would require a stoma. Our series had a 30-day mortality rate of 20 percent. 

Conclusion Surgery does have a role in palliation of symptoms of intestinal obstruction in carefully- selected patients with advanced abdominal and pelvic malignancy. Patients should be counselled on the likelihood of a stoma and the 30-day mortality risk.

Keywords: abdominal malignancy, intestinal obstruction, surgical palliation 
Singapore Med J 2009; 50(12): 1139-1144