Resection of peritoneal metastases causing malignant small bowel obstruction.
BACKGROUND
Resection of peritoneal metastases has been shown to improve survival in patients with abdominal metastatic disease from abdominal or extra abdominal malignancy. This study evaluates the benefit of peritoneal metastatic resection in patients with malignant small bowel obstruction and a past history of treated cancer.


METHODS
Patients undergoing laparotomy for resection of peritoneal metastases from recurrence of previous cancer between 1992-2003 were reviewed retrospectively. Data were collected about type of primary cancer, interval to recurrence, extent of the disease and completeness of resection, morbidity and mortality and long-term survival.


RESULTS
Between 1992 and 2003 there were 79 patients (median age 62, range 19-91) who had laparotomy for small bowel obstruction due to recurrent cancer. The primary cancer was colorectal (31), gynaecologic cancer (19), melanoma (16) and others (13). Overall, the rate of complications was 35% and mortality was 10%. Median survival was 5 months; patients with history of colorectal cancer had better survival than other cancer (median survival 7 months vs. 4 months; p = 0.02). Multivariate analysis showed that the extent of recurrent disease was the only factor that affected overall survival.


CONCLUSIONS
Laparotomy for small bowel obstruction is a worthwhile option for patients with malignant small bowel obstruction. Although it is associated with significant morbidity and mortality it offers a reasonable survival benefit in particular for patients with completely resectable disease.
Abbas
Saleh M
SM
Colorectal Unit, Auckland City Hospital, Private Bag 92024, Auckland, New Zealand. salehabbas@yahoo.com
Merrie
Arend Eh
AE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009520:New Zealand / Q000453:epidemiology; D010534:Peritoneal Neoplasms / Q000150:complications / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate