90th Annual Meeting Abstracts
Outcome of Small Bowel Obstruction In Patients With Previous Gynecological Malignancies
*Tamar L Mirensky, M.D., *Unzila A Ali, M.D., *Kevin M Schuster, M.D., *Peter E Schwartz, M.D., Walter E Longo, M.D.
Yale New Haven Hospital, New Haven, CT
Objective: General surgeons evaluate patients with previous gynecological malignancies presenting with small bowel obstructions (SBOs). Such obstructions may be caused by malignant or benign processes including adhesions or radiation injuries. We sought to determine the etiologies of SBOs and outcomes among these challenging patients.
Design: A retrospective chart review was conducted.
Setting: Single institution urban tertiary care center.
Patients: 189 patients diagnosed with cervical, endometrial or ovarian malignancies admitted to the hospital with an SBO between 1997-2004.
Main Outcome Measure: Etiology of small bowel obstruction and outcomes associated with surgical or conservative management.
Results: Malignancy was the underlying cause of SBO in 132/189 patients (69.8%). Advanced initial cancer (p=0.006; OR 6.623), ovarian malignancy (p=0.001; OR 25.64) and shorter time interval (p=0.014) between original cancer diagnosis and SBO was associated with a malignant etiology of SBO. Receipt of adjuvant chemotherapy (p<0.001; OR 0.017) or radiation therapy (p=0.027; OR 0.093) was associated with a benign process leading to an SBO. A radiographic transition point predicted operative management (p<0.001; OR 10.75). Overall, 49/189 (26%) patients required surgery with 24/49 (49%) patients having an SBO due to malignancy and 11/24 (45.8%) of these patients died of their disease. Of the remaining patients who were managed non-operatively, 70/140 (50%) died from a presumed recurrent malignancy. Nasogastric decompression, absence of abdominal pain at presentation and advanced disease were associated with increased mortality.
Conclusion: Most patients with a previous gynecological malignancy who present with an SBO are managed conservatively. Recurrent cancer is the most common etiology among this population. A malignant SBO predicts poor outcome and conservative management or palliative care should be strongly considered in this cohort of patients.