Survival with surgical versus medical treatment of patients with bowel obstruction secondary to ovarian cancer recurrence: A 15-year experience

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e16515 Background: To compare the impact of surgical versus medical management on the survival of patients presenting with small bowel obstruction (SBO) secondary to recurrent ovarian cancer. Methods: The Institutional Review Board approved a retrospective chart review of all patients with SBO due to recurrent ovarian cancer at the University of Wisconsin Hospital between January 1, 1992, and December 31, 2007. The data abstracted from patient charts included demographics, primary cancer characteristics, detailed clinical information at the time of SBO, management strategy, and outcome. Univariate analysis was performed with Cox proportional hazard model and Kaplan-Meier curves were generated for survival. Results: 71 patients met our search criteria, 6 were excluded because of a paucity of medical information. Of the 65 patients in our study, the median age was 53 years. 86% of the patients had stage III/IV ovarian cancer, while 14% had stage I/II. The median time from tumor recurrence to bowel obstruction was 17 months. 41% of patients presented with high grade bowel obstruction while 69% were low grade. 36 (55%) of patients underwent surgery for management of bowel obstruction and the remaining 29 (45%) were managed conservatively with various medical approaches. Two-year survival for the surgically managed patients was 38% compared to 18% for those who received medical treatment (p = 0.07). There was no difference in survival for patients based on histology (p = 0.38), grade (p = 0.077), grade of SBO (p = 0.56). Patients with stage I/II had a median survival of 50 months versus stage III/IV at 3.5 months (p = 0.01). Median survival for patients without ascites at time of SBO was 9.5 months while those with ascites was 3 months (p = 0.0004). Patients without abdominal or pelvic mass on CT had a median survival of 60 months; patients with any mass noted had a median survival of 3.6 months; patients with liver and lung metastases was 3 months (p = 0.001). Conclusions: In patients with bowel obstruction due to ovarian cancer recurrence; early stage at diagnosis, the absence of ascites, and lack of abdominal/pelvic mass or distant metastases significantly lengthens survival. There is a trend towards the superiority of surgical management in these patients. No significant financial relationships to disclose.