992P - Bowel Obstruction in Ovarian and Peritoneal Malignancy: the Christie Hospital (MANCHESTER, UK) Experience

Abstract

Bowel Obstruction in Ovarian and Peritoneal Malignancy: The Christie Hospital (Manchester, UK) ExperienceBACKGROUND: Bowel obstruction is a common clinical problem in advanced ovarian and peritoneal malignancy and is associated with a poor prognosis. We previously correlated clinical & radiological factors with outcome demonstrating that significant improvements in overall survival can be gained in a minority of patients1. Here, we extend our analysis to 130 patients with biopsy-proven disease admitted between 2003-2011 with the aims of identifying patients most likely to derive benefit from palliative surgery and/or chemotherapy. RESULTS: The median time from diagnosis to inpatient admission with bowel obstruction was 493 days (range 0-5640). The most common histology was serous adenocarcinoma (44%). The median inpatient stay was 20 days (range 3-110); total parenteral nutrition was instigated in 22% (median duration 14 days). The majority of patients had high (> 5cm) tumour burden at multiple sites, radiological evidence of serosal disease and half developed bowel obstruction whilst receiving chemotherapy. Approximately 50% of patients presented with obstructive symptoms, but 25% presented with erratic bowel habit. Median survival following the first episode of bowel obstruction was 87 days (range 3-1754). Survival was similar between patients who underwent palliative surgery or chemotherapy (p=0.89). Median survival for patients presenting in bowel obstruction with platinum-sensitive (PS) and platinum-resistant (PR) disease (but not chemona�ve patients) who proceeded to chemotherapy was prolonged compared with patients unsuitable for further treatment (PS 191 vs. 24 days, p<0.0001; PR 149 vs. 50 days, p=0.06). A feasibility trial investigating the efficacy of low residue diet and intravenous dexamethasone in the prevention and treatment of malignant bowel obstruction has been initiated.CONCLUSION: Overall survival in patients with malignant bowel obstruction is poor with no significant improvement over the last decade. Bowel obstruction in patients with chemona�ve disease represents an aggressive phenotype with poor prognosis. Judicious selection of patients for surgery and/or chemotherapy can significantly increase survival.