title: Bowel obstruction and peritoneal carcinomatosis in the elderly. A systematic review.
abstract: BACKGROUND
  There are not guidelines for surgical management of malignant bowel obstruction (MBO) caused by peritoneal carcinomatosis (PC), mainly when it involves elderly; so its treatment is still debated.
  
  
  OBJECTIVE
  To outline indications and benefits of palliative surgery for obstructive carcinomatosis and determine what prognostic factors, including age, have independent and significant association with outcome.
  
  
  METHODS
  We conducted English-language MEDLINE and EMBASE searches of articles published between 1998 and 2016, which reported outcome data after palliative surgery for MBO due to PC. We excluded all articles lacking of surgical cohort and those with main interest in conservative treatment. Of 1275 articles identified, 12 satisfied selection criteria and were included in our analysis.
  
  
  RESULTS
  Overall, these studies involved 548 patients undergoing palliative surgery for MBO caused by PC. The median age was 58 (range 19-93). Relief of symptoms was achieved in 26.5-100% of cases. Postoperative morbidity ranged between 7 and 44%. Mortality was high (6-22%). The median survival was longer in surgical patients than in those receiving conservative therapy (8-34 vs 4-5 weeks). Factors associated with surgery failure were poor performance status, diffuse carcinomatosis, previous radiotherapy, and obstruction of small bowel. Old age was significantly associated with a poor prognosis upon univariate analysis, while this association vanished upon multivariate analysis.
  
  
  CONCLUSIONS
  Surgical palliation can provide relief of obstructive symptoms as well as improved survival in well-selected patients, even if elderly.
authors.affiliation: Abdominal Surgery and Transplantation, Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131, Naples, Italy. michele.santangelo@unina.it.
authors.forename: Michele L
authors.identifier: http://orcid.org/0000-0003-3046-9988
authors.initials: ML
authors.lastname: Santangelo
authors.affiliation: Abdominal Surgery, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Grifasi
authors.affiliation: Division of Experimental Cancer Medicine, European Institute of Oncology, Milan, Italy.
authors.forename: Carmen
authors.initials: C
authors.lastname: Criscitiello
authors.affiliation: Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.|Cancer Center, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Giuliano
authors.affiliation: Abdominal Surgery, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
authors.forename: Armando
authors.initials: A
authors.lastname: Calogero
authors.affiliation: Emergency Surgery, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
authors.forename: Concetta
authors.initials: C
authors.lastname: Dodaro
authors.affiliation: Abdominal Surgery and Transplantation, Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131, Naples, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Incollingo
authors.affiliation: Abdominal Surgery and Transplantation, Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131, Naples, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Rupealta
authors.affiliation: Abdominal Surgery, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Candida
authors.affiliation: Abdominal Surgery, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Chiacchio
authors.affiliation: Department of Public Health, University Federico II, Naples, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Riccio
authors.affiliation: Department of Public Health, University Federico II, Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pisani
authors.affiliation: Abdominal Surgery and Transplantation, Department of Advanced Biomedical Sciences, University Federico II, via Pansini 5, 80131, Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tammaro
authors.affiliation: Abdominal Surgery, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Carlomagno
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000150:complications / Q000473:pathology; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010166:Palliative Care / Q000379:methods; D010534:Peritoneal Neoplasms / Q000150:complications / Q000473:pathology; D011379:Prognosis
keywords: Elderly; Malignant bowel obstruction; Performance status; Peritoneal carcinomatosis; Surgical palliation