Management Of Malignant Bowel Obstruction Research Articles

Surgical management of malignant bowel obstruction: Strategies toward palliation of patients with advanced cancer

The management of malignant bowel obstruction is a challenging problem because of the poor definition of malignant bowel obstruction compounded by its myriad clinical presentations. Surgeons are called upon to perform invasive procedures designed to alleviate symptoms or correct the underlying obstruction. Unfortunately, interventions may carry a high rate of morbidity and mortality. Balancing these risks and potential benefits is complicated, and there is a paucity of data to help guide these difficult decisions. The surgeon is further handicapped when he or she is not understanding of the patient's disease status, prognosis, or long-term goals. Diligent discussion with the primary team and frank discussions with the patient and his or her family are essential to formulate an appropriate plan. It is also essential that the surgeon have a thorough understanding of the surgical options to relieve or palliate malignant bowel obstruction as well as effective nonsurgical interventions. The best approach may be appropriate surgical intervention coupled with aggressive medical management.

Current concepts in malignant bowel obstruction management

Malignant bowel obstruction (MBO) is a challenging complication of advanced cancer. Several pathophysiologic mechanisms are responsible for the syndrome, including mechanical compression, motility disorders, gastrointestinal secretion accumulation, decreased gastrointestinal absorption, and inflammation. The treatment of related symptoms requires a collaborative approach of surgical, interventional, and medical specialists. The surgical approach proves beneficial in selected patients with operable lesions, life expectancy greater than 2 months, and good performance status. Interventionalists place self-expanding metallic stents as a minimally invasive palliative method either as a definitive treatment or as a bridge to surgery. However, most patients with MBO are not candidates for surgery or stent placement. Medical management with opioids, antispasmodics, antiemetics, antisecretory agents, and corticosteroids is effective in controlling the symptoms associated with MBO. This article discusses the current understanding of MBO pathophysiology and emphasizes current MBO management concepts; it then reviews surgical, interventional, and medical approaches.

Should Colonic Stents Be Used First Line in the Management of Malignant Bowel Obstruction?

Should Colonic Stents Be Used First Line in the Management of Malignant Bowel Obstruction?

Management of malignant bowel obstruction

Malignant bowel obstruction (MBO) is a common and distressing outcome particularly in patients with bowel or gynaecological cancer. Radiological imaging, particularly with CT, is critical in determining the cause of obstruction and possible therapeutic interventions. Although surgery should be the primary treatment for selected patients with MBO, it should not be undertaken routinely in patients known to have poor prognostic criteria for surgical intervention such as intra-abdominal carcinomatosis, poor performance status and massive ascites. A number of treatment options are now available for patients unfit for surgery. Nasogastric drainage should generally only be a temporary measure. Self-expanding metallic stents are an option in malignant obstruction of the gastric outlet, proximal small bowel and colon. Medical measures such as analgesics according to the W.H.O. guidelines provide adequate pain relief. Vomiting may be controlled using anti-secretory drugs or/and anti-emetics. Somatostatin analogues (e.g. octreotide) reduce gastrointestinal secretions very rapidly and have a particularly important role in patients with high obstruction if hyoscine butylbromide fails. A collaborative approach by surgeons and the oncologist and/or palliative care physician as well as an honest discourse between physicians and patients can offer an individualised and appropriate symptom management plan.

Ethical Issues in Research to Improve the Management of Malignant Bowel Obstruction: Challenges and Recommendations

Research to improve the care of patients with malignant bowel obstruction (MBO) is urgently needed. In particular, there is an urgent need for high-quality descriptive research, including prospective cohort studies, as well as randomized controlled trials to define optimal management strategies. However, investigators and clinicians face numerous barriers in conducting high-quality research in this patient population. These barriers include lack of funding, difficulties in identifying eligible patients, and a variety of practical and methodological challenges of designing these studies. In addition, there are a variety of ethical challenges that arise in the design and conduct of studies of MBO and particularly in the conduct of clinical trials. In this article, we address four categories of ethical issues: study design, recruitment, informed consent, and Institutional Review Board review. For each, we outline salient issues and suggest recommendations for enhancing the ethics of MBO studies, including interventional trials.

Successful Management of Malignant Bowel Obstruction

Successful Management of Malignant Bowel Obstruction

Successful Management of Malignant Bowel Obstruction

Bowel obstruction is a common problem in patients with abdominal and pelvic malignancies. At the end of life, many patients with this diagnosis are not candidates for surgical intervention to alleviate the obstruction. These patients require thorough assessment and thoughtful interventions as the goal of care shifts to providing comfort and managing symptoms. This article reviews the palliative care of patients with malignant bowel obstruction and presents the successful control of pain, nausea, and vomiting in a 67-year-old woman with metastatic ovarian cancer.

Palliative management of malignant bowel obstruction.

Bowel obstruction may be a mode of presentation of intra-abdominal and pelvic malignancy or a feature of recurrent disease following anticancer therapy. Malignant bowel obstruction is well-recognized in gynecologic patients with advanced cancer. Retrospective and autopsy studies found the frequency at approximately 5-51% of patients with gynecological malignancy(1-7). Malignant bowel obstruction (MBO) is particularly frequent in patients with ovarian cancer where it is the most frequent cause of death(7). Patients with stage III and IV ovarian cancer and those with high-grade lesions are at higher risk for MBO as compared to patients with lower stage or low-grade tumors(1,8). Ovarian carcinoma accounted for 50% of small bowel obstruction and 37% of large bowel obstruction treated in a large gynecological oncology service(8-11).

Palliative Management of Malignant Bowel Obstruction

Palliative Management of Malignant Bowel Obstruction

Successful management of malignant bowel obstruction.

Although perhaps not one of the most common symptoms encountered in specialist palliative care units, health professionals frequently come across malignant bowel obstruction in general hospital wards, emergency rooms and in the community. The age-old approach to management of this problem using a nasogastric tube and intravenous therapy may still have its place for some patients, but specialists in palliative care have pioneered a kinder approach aimed at treating associated symptoms of colicky pain, nausea and vomiting. We owe it to our patients to ensure that all our colleagues are familiar with the most up-to-date treatment of malignant bowel obstruction to minimize distress and enhance quality of life.

Management of Malignant Bowel Obstruction in Advanced Cancer: A Brief Review

Malignant bowel obstruction is an odious complication of numerous malignancies, most notably ovarian and colorectal cancers. It reduces quality of life and promotes considerable physical and emotional suffering, precluding a peaceful and comfortable death and deterring appropriate familial bereavement. Palliative management of bowel obstruction includes operative and nonoperative strategies, with therapeutic selection based on patient preference and anticipated life expectancy. Available therapies include laparotomy, enteral intubation, intravenous and subcutaneous hydration, parenteral nutrition, and pharmacologic agents.

Percutaneous transgastric intestinal decompression: the management of malignant bowel obstruction without nasal intubation.

We inserted a long intestinal tube via the percutaneous transgastric route in three patients with an inoperable malignant bowel obstruction. The percutaneous endoscopic gastrostomy technique facilitated this method. The main purpose of our procedure is to achieve direct intestinal decompression without nasal intubation, which is not always possible by venting gastrostomy alone. Palliative intestinal decompression proved to be effective in all patients. This alternative therapeutic strategy for managing bowel obstruction in terminal cancer patients is herein presented.