title: Outcomes of small bowel obstruction in patients with previous gynecologic malignancies.
abstract: BACKGROUND
  Features predictive of malignant small bowel obstructions among patients with previous gynecologic malignancies remain undetermined.
  
  
  METHODS
  Predictors of malignancy and mortality among patients with gynecologic malignancies and bowel obstructions were identified through a retrospective review of records.
  
  
  RESULTS
  Malignancy was noted among 69.8% of 189 patients included in the analysis. Advanced-stage cancer (P = .006, odds ratio [OR] = 6.62), ovarian malignancy (P = .001, OR = 25.64), and early-onset obstruction (P = .014) predicted malignant etiology, whereas chemotherapy (P < .001, OR = .02) or radiation therapy (P = .027, OR = .09) predicted benign obstruction. The average survival was 9 months versus 49 months for malignant and benign obstructions, respectively. Ovarian cancer (P = .009, hazard ratio [HR] = 4.45), anemia (P = .001, HR = 1.11), and renal dysfunction (P < .001, HR 1.81) impaired survival.
  
  
  CONCLUSIONS
  Palliative care should be considered for patients with advanced-stage cancer, ovarian malignancy, and a shorter time interval between cancer diagnosis and bowel obstruction, especially in the setting of anemia and renal dysfunction.
authors.affiliation: Department of Surgery, Yale University School of Medicine, Office of Surgical Education, New Haven, CT 06520-8062, USA. tamar.mirensky@yale.edu
authors.forename: Tamar L
authors.initials: TL
authors.lastname: Mirensky
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Schuster
authors.forename: Unzila A
authors.initials: UA
authors.lastname: Ali
authors.forename: Vikram
authors.initials: V
authors.lastname: Reddy
authors.forename: Peter E
authors.initials: PE
authors.lastname: Schwartz
authors.forename: Walter E
authors.initials: WE
authors.lastname: Longo
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D007421:Intestine, Small / Q000473:pathology*; D008875:Middle Aged; D016017:Odds Ratio; D010166:Palliative Care / Q000379:methods*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors