Document Detail


Pneumoperitoneum in the cancer patient.
MedLine Citation:
PMID:  17680315     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cancer patients may be at increased risk for pneumoperitoneum due to local tumor invasion, immunosuppression, chemotherapy, and frequent endoscopy. The purpose of this study was to characterize clinical presentations and management strategy for pneumoperitoneum in cancer patients. METHODS: All patients with an ICD-9 diagnosis of visceral perforation or who had undergone a surgical oncology consultation between January 2000 and October 2006 were identified. Those patients with evidence of pneumoperitoneum on radiography underwent chart review. Patients were grouped according to treatment with or without surgery and results were compared using Chi-square and Kaplan Meier analysis. RESULTS: Of 1,750 patients identified, 123 had 124 episodes of pneumoperitoneum. Treatment given was comfort care (n = 19), non-operative management (n = 33), or surgery (n = 72). Disease stage was IV in 89% of the comfort care group, 70% of the non-operative group, and 65% of the surgery group (P = 0.6). Factors predictive of management on univariate analysis were the presence of symptoms at presentation, abdominal tenderness, fever, pneumatosis on imaging, and prior abdominal radiation; but only fever, abdominal tenderness, and abdominal radiation were significant in multivariate analysis. With comfort care, non-operative management, and surgery, 30-day mortality rates were 100%, 12%, and 15%, respectively. CONCLUSIONS: Pneumoperitoneum in cancer patients requires a tailored approach that considers both clinical presentation and oncological prognosis. Conventional wisdom for surgical evaluation--symptom severity, pain, and tenderness--still applies, but some patients can be successfully treated without surgery.
Authors:
Brian Badgwell; Barry W Feig; Merrick I Ross; Paul F Mansfield; Sijin Wen; George J Chang
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Publication Detail:
Type:  Journal Article     Date:  2007-08-07
Journal Detail:
Title:  Annals of surgical oncology     Volume:  14     ISSN:  1534-4681     ISO Abbreviation:  Ann. Surg. Oncol.     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-10-16     Completed Date:  2008-01-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9420840     Medline TA:  Ann Surg Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3141-7     Citation Subset:  IM    
Affiliation:
Department of Surgical Oncology, Unit 444, The University of Texas M. D. Anderson Cancer Center, 1400 Holcombe Boulevard, P.O. Box 301402, Houston, Texas 77030-1402, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Female
Humans
Middle Aged
Neoplasms / complications*,  therapy
Pneumoperitoneum / etiology*,  therapy
Prognosis
Survival Rate

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