title: Surgical management of bowel obstruction in patients with peritoneal carcinomatosis.
abstract: BACKGROUND
  Due to low life expectancy, treatment strategies for malignant bowel obstruction (MBO) due to peritoneal carcinomatosis (PC) emphasize improved quality of life and symptom relief. Currently, the value of palliative surgery to treat obstructive PC is unclear.
  
  
  METHODS
  A prospectively registered search strategy (PROSPERO) was utilized to identify articles examining outcomes of patients undergoing surgical palliation for MBO from PC in PubMed (2003-2013). Primary outcomes of interest were median overall survival (OS) and treatment complications.
  
  
  RESULTS
  Of 730 articles screened, 64 were selected for full-text review and 5 were quantitatively synthesized. This comprised 313 patients with MBO, of which 249 (79.5%) presented with PC. The mean age was 61.4 years (range 51-67). The OS for surgical patients was 6.4 months (2.8-19.7, n = 190). Stratification by surgical technique suggested an OS of resection, ostomy, and enteral bypass as 7.2 months (n = 174), 3.4 months (n = 9), and 2.7 months (n = 7), respectively. Major complications occurred in 37.0% of patients that underwent resection.
  
  
  CONCLUSIONS
  This study supports surgical resection over surgical bypass to treat obstructive PC, as it offered better OS with fewer complications. Higher quality studies are needed to conclusively assess the role of surgery in patients with obstructive PC.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Bahbak
authors.initials: B
authors.lastname: Shariat-Madar
authors.forename: Thejus T
authors.initials: TT
authors.lastname: Jayakrishnan
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Turaga
mesh_terms: D000714:Anastomosis, Surgical; D002277:Carcinoma / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003125:Colostomy; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D010030:Ostomy; D010166:Palliative Care; D010534:Peritoneal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D011788:Quality of Life
keywords: colostomy; intestinal bypasses; neoplasms; palliative care; stents