Surgical approaches to malignant bowel obstruction.
The management of patients with malignant bowel obstruction (MBO) can be one of the most challenging aspects of advanced cancer care, and as a result, their symptoms are often palliated poorly, especially near the end of life. The term MBO encompasses a heterogeneous clinical syndrome,defined as obstructive symptoms due to the presence of intra-abdominal neoplastic disease. Radiological imaging, particularly with computed tomography, is critical in determining the cause of obstruction and possible therapeutic interventions. Options include laparotomy with or without a stoma, decompression with a stent, or aggressive medical therapy. Surgical decision-making involves the selection of the intervention most likely to relieve symptoms and improve quality of life for a particular patient at that particular point along his or her disease course. Although MBO is a relatively common dilemma encountered in clinical practice, there are no simple treatment guidelines or algorithms to follow. Instead, each patient must be assessed individually to devise a treatment plan that best balances the advantages and disadvantages of the intervention, considering the patient's prognosis, tumor biology, and-most importantly-his or her goals of care, as determined through an honest discourse between physician and patient. This review outlines a surgical framework for clinicians managing patients with MBO.
Helyer
Lucy
L
Dalhousie University, Halifax, Nova Scotia, Canada.
Easson
Alexandra M
AM
D000008:Abdominal Neoplasms / Q000150:complications* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000150:complications* / Q000473:pathology / Q000556:secondary; D002404:Catheterization; D003657:Decision Making; D013505:Digestive System Surgical Procedures / Q000523:psychology; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010166:Palliative Care / Q000523:psychology; D019919:Prosthesis Implantation / Q000295:instrumentation; D015607:Stents