| Management of Patients with Malignant Bowel Obstruction and Stage IV Colorectal Cancer. | |
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MedLine Citation:
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PMID: 21595546 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Abstract Background: Malignant bowel obstruction (MBO), a serious problem in stage IV colorectal cancer (CRC) patients, remains poorly understood. Optimal management requires realistic assessment of treatment goals. This study's purpose is to characterize outcomes following palliative intervention for MBO in the setting of metastatic CRC. Study Design: Retrospective review of a prospective palliative database identified 141 patients undergoing surgical (OR; n = 96) or endoscopic (GI; n = 45) procedures for symptoms of MBO. Results: Median patient age was 58 years, median follow-up 7 months. Most (63%) had multiple sites of metastases. Computed tomography (CT) scan findings of carcinomatosis (p = 0.002), ascites (p = 0.05), and multifocal obstruction with carcinomatosis and ascites (p = 0.03) significantly predicted the need for percutaneous or open gastrostomy tube, or stoma. Procedure-associated morbidity for 81 patients with small bowel obstruction (SBO) was 37%; 7% developed an enterocutaneous fistula/anastomotic leak. Thirty-day mortality was 6%. Most (84%) patients were palliated successfully; some received additional chemotherapy (38%) or surgery (12%). Procedure-associated morbidity for 60 patients with large bowel obstruction (LBO) was 25%; 11 patients (18%) required other procedures for stent failure, with one death at 30 days. Symptom resolution was >97%. Patients with LBO had improved symptom resolution, shorter length of stay (LOS), and longer median survival than patients with SBO. Conclusions: Patients with MBO and stage IV CRC were successfully palliated with GI or OR procedures. Patients with CT-identified ascites, carcinomatosis, or multifocal obstruction were least likely to benefit from OR procedures. CT plays an important role in preoperative planning. Sound clinical judgment and improved understanding are required for optimal management of MBO. |
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Authors:
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Kimberly Moore Dalal; Marc J Gollub; Thomas J Miner; W Douglas Wong; Hans Gerdes; Mark A Schattner; David P Jaques; Larissa K F Temple |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-5-19 |
Journal Detail:
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Title: Journal of palliative medicine Volume: - ISSN: 1557-7740 ISO Abbreviation: - Publication Date: 2011 May |
Date Detail:
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Created Date: 2011-5-20 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9808462 Medline TA: J Palliat Med Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1 Department of Surgery, Memorial Sloan-Kettering Cancer Center , New York, New York. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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