Tu1072 MANAGEMENT OF RECURRENT MALIGNANT GASTROINTESTINAL OBSTRUCTION IN PATIENTS WITH PERITONEAL CARCINOMATOSIS AND THE PREDICTORS OF OUTCOME

Abstract

Malignant gastrointestinal obstruction (MGIO) is an alarming complication in patients with peritoneal carcinomatosis (PC). Palliative surgery and enteral stenting offer symptomatic relief but recurrence can occur. We aimed to investigate the treatment outcomes in the recurrent MGIO cases managed surgically or endoscopically and identify predictors of success in endoscopic management. Consecutive patients who had MGIO with PC and achieved clinical resolution from palliative surgery or enteral stenting were reviewed from 2000 to 2018 at a tertiary care center. Patients who did not achieve initial clinical resolution were excluded. Recurrence was defined as a recurrence of obstructive symptoms with confirmed radiological imaging. Binary logistic regression was used to identify potential predictors of recurrence. Eighty-two patients who originally were successfully managed either endoscopically (45 patients) or surgically (37 patients) were included in this study. At a median time of 65 (interquartile range 15-302) days, recurrence was observed in 16/45 (35.5%) patients who originally underwent stenting and in 17/37 (45.9%) patients who were originally managed surgically. None of the recurrences in stent group were offered surgery, 15 were managed endoscopically (re-stenting in 12, decompression gastro-jejunal tubes in 3) and 1 was managed conservatively. 8/15 (53%) endoscopically managed patients remained symptom free for a mean duration of 141.3 ± 129.7 days or till their death. Of the 17 recurrences in the original surgical group, 7 were endoscopically managed (5 with stents and 2 with decompression gastro-jejunal tubes), 5 underwent repeat surgery and 5 were conservatively managed. 2/7 (29%) endoscopically managed patients and 4/5 (80%) surgically managed patients remained symptom free for a mean duration of 144.5 ± 71.42 days and 489.25 ± 288.84 days respectively. Although not statistically significant, in the 22/33(66.7 %) recurrent cases that underwent endoscopic management, female gender (OR=3) and primary cancer of urogynecological type (OR= 6.43) favored failure whereas deployment of more than one stent (OR=0.38) favored success. Minimally-invasive endoscopic interventions in patients of MGIO with PC is a palliative option that is effective in half of the patients. Deployment of more than one stent is associated with success whereas female gender and urogynecological cancer are associated with failure of endoscopic management in recurrent cases.