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10.1245/s10434-006-9303-6
Annals of Surgical Oncology 14:1264-1271 (2007)
© 2007 Society of Surgical Oncology
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Original Article

Surgery as a Bridge to Palliative Chemotherapy in Patients with Malignant Bowel Obstruction from Colorectal Cancer

Lucy K. Helyer1, Calvin H. L. Law1, Mathew Butler1,2, Linda D. Last1, Andrew J. Smith1 and Frances C. Wright1

1 Department of Surgical Oncology, Sunnybrook and Women’s College Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room T2-063, Toronto, ON M4N 3M5, Canada
2 Department of Surgery, University of Alberta, Alberta, Canada

Correspondence: Address correspondence and reprint requests to: Frances C. Wright; E-mail: frances.wright{at}sunnybrook.ca

Background: Malignant bowel obstruction (MBO) is a feature of the clinical course of 10–28% of colorectal cancer (CRC) patients and is associated with a poor prognosis. Recent advancements in palliative chemotherapy regimens have prolonged survival in patients with stage IV CRC. Few reports exist that describe outcomes in patients who have had surgery for MBO and subsequent chemotherapy as part of their treatment. The objective of this study was to review surgical outcomes in patients with MBO for CRC and to evaluate the extent to which surgery can serve as a bridge to palliative chemotherapy.

Methods: Patients who presented with MBO and had surgical treatment were identified from a prospectively kept database at a single tertiary care center between 09/99 and 08/04. Charts were retrospectively reviewed and clinical and outcomes data were abstracted.

Results: Forty-seven patients were identified who had surgery as part of the treatment for MBO from CRC. Operations included resections, bypasses and stoma creation. Overall, 80% of patients were able to tolerate solid food post-operatively and return home. The median survival for the entire cohort was 3.5 months. Seven patients died within 30 days of surgery. Of the remainder, 24 patients were palliated with surgery alone and 16 patients ultimately received palliative chemotherapy. Survival in the final cohort was significantly prolonged (P < 0.001).

Conclusion: Surgery can adequately palliate a substantial proportion of patients with MBO from CRC with acceptable morbidity and mortality. In addition, in a subset of patients it can facilitate palliative chemotherapy that is associated with improved overall survival.

Key Words: Malignant bowel obstruction • Colorectal adenocarcinoma • Palliative chemotherapy • Survival • Surgery






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Copyright © 2007 by the Society of Surgical Oncology.