Background:
Malignant bowel obstruction (MBO) is a frequent complication of advanced malignancies, however there is minimal published data on variables associated with outcomes. We aimed to analyse outcomes of patients with MBO at a large Australian tertiary cancer centre.
Methods:
We performed a retrospective review of patients admitted with MBO from Jan-2019 to Dec-2019. The Kaplan-Meier method was used to estimate survival time and associations with clinical variables.
Results:
89 presentations of MBO from 69 patients were identified. Median age was 63 years and 49% were male. 44 patients (64%) had a gastrointestinal malignancy, 13 (19%) gynaecological and 12 (17%) other primaries. Peritoneal disease was present on imaging in 43 patients (62%) and 35 patients (51%) had previous MBO.
Of the 89 MBO presentations, 17 (19%) resulted in inpatient death and 30 (43%) patients died within 90 days of their first MBO. Median overall survival (OS) was 108 days. Significant predictors of poor OS included presence of peritoneal disease, previous MBO, albumin <30g/L and lack of documented low fibre diet education.
Of the 72 presentations that were discharged, 50% were readmitted within 90 days. The only variable that was significantly associated with readmission was previous MBO (p=0.0016). Although 50%, 35% and 63% of patients were discharged with steroids, laxatives and a low fibre diet respectively, none of these measures were significantly associated with a reduction in readmission rate. 21 (30%) patients received further systemic therapy.
17 patients received surgical intervention for their MBO and had improvement in OS (90-Day OS rate 71% vs 52%; median OS 108d vs 97d) compared to those managed with a conservative approach, but this was not statistically significant (p=0.26).
Conclusions:
Patients with MBO had poor survival and high rates of readmission. A more structured approach to MBO may help to alleviate symptoms and prevent readmissions.