title: Management of bowel obstruction in patients with stage IV cancer: predictors of outcome after surgery.
abstract: BACKGROUND
  Patients with stage IV cancer and bowel obstruction (BO) present a complicated management problem. We sought to determine if specific parameters could predict outcome after surgery.
  
  
  METHODS
  Records of patients with stage IV cancer and BO treated from 1991 to 2008 were reviewed. For surgical patients, 30-day morbidity and 90-day mortality were assessed using exact multivariable logistic regression methods.
  
  
  RESULTS
  Of 198 patients, 132 (66.7%) underwent surgery, 66 medical treatment alone, and demographics were similar. A total of 41 patients (20.7%) were diagnosed with stage IV cancer and BO synchronously, all treated surgically; the remaining presented metachronously. Medically managed patients were more likely to have received chemotherapy in the 30 days prior to BO (45 of 66 [68.2%] vs 40 of 132 [30.3%], p < .01). In the surgical group, 30-day morbidity was 35.6%, while 90-day mortality was 42.3%. Median overall survival for synchronous patients was 14.1 months (95% confidence interval [95% CI] 7.6-23.2), and 3.7 months (95% CI 2.5-5.2) and 3.6 months (95% CI 1.5-5.2) for metachronous patients treated surgically and medically, respectively. A multivariate model for 90-day surgical mortality identified low serum albumin, metachronous presentation, and ECOG > 1 as predictors of death (p < .05). A model for 30-day surgical morbidity yielded low hematocrit as a predictive factor (p < .05).
  
  
  CONCLUSIONS
  This cohort identifies characteristics indicative of morbidity and mortality in stage IV cancer and BO. Low serum albumin, ECOG > 1, and metachronous presentation predicted for 90-day surgical mortality. These data suggest factors that can be used to frame treatment discussion plans with patients.
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA. valerie.francescutti@roswellpark.org
authors.forename: Valerie
authors.initials: V
authors.lastname: Francescutti
authors.forename: Austin
authors.initials: A
authors.lastname: Miller
authors.forename: Yashodhara
authors.initials: Y
authors.lastname: Satchidanand
authors.forename: Amy
authors.initials: A
authors.lastname: Alvarez-Perez
authors.forename: Kelli Bullard
authors.initials: KB
authors.lastname: Dunn
mesh_terms: D019468:Disease Management; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D008297:Male; D009017:Morbidity; D009367:Neoplasm Staging; D009369:Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery; D010166:Palliative Care; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate