Malignant Bowel Obstruction in Advanced Gynecologic Cancers: An Updated Review from a Multidisciplinary Perspective.

Yeh Chen Lee,Terri Stuart-Mcewan,Nazlin Jivraj,Lisa Tinker,Eran Shlomovitz,Jennifer Croke,Johane P Allard,Sarah E Ferguson,Pamela Savage,Preeti Dhar,Amit M Oza,Tanya Chawla,Jenny Lau,Catherine O’Brien,Pamela Ng,Sarah Buchanan,Marcus O Butler ,Stéphane Laframboise ,Neesha C Dhani ,Stéphanie Lheureux

doi:10.1155/2018/1867238

Abstract

Malignant bowel obstruction (MBO) is a major complication in women with advanced gynecologic cancers which imposes a significant burden on patients, caregivers, and healthcare systems. Symptoms of MBO are challenging to palliate and result in progressive decompensation of already vulnerable patients with limited therapeutic options and a short prognosis. However, there is a paucity of guidelines or innovative approaches to improve the care of women who develop MBO. MBO is a complex clinical situation that requires a multidisciplinary approach to ensure the appropriate treatment modality and interprofessional care to optimally manage these patients. This review summarizes the current literature on the different approaches targeting MBO management including surgical intervention, chemotherapy, total parenteral nutrition, and pharmacological treatment. In addition, the impact of MBO management on patients' quality of life (QOL) is examined. This article focuses on the challenges in developing evidence-based treatment guidelines for MBO and barriers in clinical trial design for MBO and proposes strategies to advance the MBO management. Collaboration is essential to design studies that may improve the overall care and quality of life for these patients. Prospective data are needed to inform clinical practice, establish a new benchmark for evidence-based MBO management, and better understand the biology of MBO.

Highlights

Malignant bowel obstruction (MBO) in women with advanced gynecologic cancer is common and a major clinical challenge as it is associated with protracted symptoms such as the inability to maintain oral intake, vomiting, and abdominal pain
Small bowel obstruction is more common than large bowel obstruction (61% versus 33%, resp.) [47, 48]. e majority of MBO occurs due to external compression or functional occlusion of the gastrointestinal tract from peritoneal carcinomatosis or tumor infiltration of bowel muscle/nerves [49]
Its measure for quality of life (QOL), has been evaluated among patients undergoing stent or diverting colostomy [79, 80]. Whilst both methods were found to be effective in palliating symptoms of MBO, stent placement was associated with improved QOL related to gastrointestinal function [81]

Summary

Introduction

Malignant bowel obstruction (MBO) in women with advanced gynecologic cancer is common and a major clinical challenge as it is associated with protracted symptoms such as the inability to maintain oral intake, vomiting, and abdominal pain. Median survival was longer (124–408 days) [5, 7,8,9,10] for those selected patients who underwent palliative surgical intervention. Majority of these women would experience recurrent episodes of MBO over their short life expectancy [11]. We will examine recent advances in the literature targeting different modalities and aspects of MBO management, including palliative surgical intervention [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28], chemotherapy [28,29,30], pharmacological management of symptoms [31,32,33,34,35,36,37,38,39,40], total parenteral nutrition (TPN) [30, 41,42,43,44,45,46], and quality of life (QOL) in patients with MBO

Diagnosis of MBO

Surgical Intervention for MBO

Pharmacological Management of MBO

Findings

Conclusions and Perspectives