Natural History and Management of Small-Bowel Obstruction in Patients After Cytoreductive Surgery and Intraperitoneal Chemotherapy

Background Small-bowel obstruction (SBO) after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a common complication associated with re-admission that may alter patients’ outcomes. Our aim was to characterize and investigate the impact of bowel obstruction on patients’ prognosis. Methods This was a retrospective analysis of patients with SBO after CRS/HIPEC (n = 392). We analyzed patients’ demographics, operative and perioperative details, SBO re-admission data, and long-term oncological outcomes. Results Out of 366 patients, 73 (19.9%) were re-admitted with SBO. The cause was adhesive in 42 (57.5%) and malignant (MBO) in 31 (42.5%). The median time to obstruction was 7.7 months (range, 0.5–60.9). Surgical intervention was required in 21/73 (28.7%) patients. Obstruction eventually resolved (spontaneous or by surgical intervention) in 56/73 (76.7%) patients. Univariant analysis identified intraperitoneal chemotherapy agents: mitomycin C (MMC) (HR 3.2, p = 0.003), cisplatin (HR 0.3, p = 0.03), and doxorubicin (HR 0.25, p = 0.018) to be associated with obstruction-free survival (OFS). Postoperative complications such as surgical site infection (SSI), (HR 2.2, p = 0.001) and collection (HR 2.07, p = 0.015) were associated with worse OFS. Multivariate analysis maintained MMC (HR 2.9, p = 0.006), SSI (HR 1.19, p = 0.001), and intra-abdominal collection (HR 2.19, p = 0.009) as independently associated with OFS. While disease-free survival was similar between the groups, overall survival (OS) was better in the non-obstruction group compared with the obstruction group (p = 0.03). Conclusions SBO after CRS/HIPEC is common and complex in management. Although conservative management was successful in most patients, surgery was required more frequently in patients with MBO. Patients with SBO demonstrate decreased survival..

Medienart:

E-Artikel

Erscheinungsjahr:

2022

Erschienen:

2022

Enthalten in:

Zur Gesamtaufnahme - volume:29

Enthalten in:

Annals of surgical oncology - 29(2022), 13 vom: 08. Aug., Seite 8566-8579

Sprache:

Englisch

Beteiligte Personen:

Mor, Eyal [VerfasserIn]
Shemla, Shanie [VerfasserIn]
Assaf, Dan [VerfasserIn]
Laks, Shachar [VerfasserIn]
Benvenisti, Haggai [VerfasserIn]
Hazzan, David [VerfasserIn]
Shiber, Mai [VerfasserIn]
Shacham-Shmueli, Einat [VerfasserIn]
Margalit, Ofer [VerfasserIn]
Halpern, Naama [VerfasserIn]
Boursi, Ben [VerfasserIn]
Beller, Tamar [VerfasserIn]
Perelson, Daria [VerfasserIn]
Purim, Ofer [VerfasserIn]
Zippel, Douglas [VerfasserIn]
Ben-Yaacov, Almog [VerfasserIn]
Nissan, Aviram [VerfasserIn]
Adileh, Mohammad [VerfasserIn]

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Anmerkungen:

© Society of Surgical Oncology 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

doi:

10.1245/s10434-022-12370-x

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2132633703

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