Prognostic Factors for Surgical Failure in Malignant Bowel Obstruction and Peritoneal Carcinomatosis

Frontiers in Surgery

Elena Rodolfino²  Giovanni Scambia³  Anna Fagotti³  Francesco Giovinazzo⁴  Claudio Lodoli⁵  Francesco Santullo⁵  Stefano Rotolo⁵  Andrea Di Giorgio⁶  Marcello Covino⁶  Francesco Franceschi⁶  Miriam Attalla El Halabieh⁶  Carlo Abatini⁶  Fabio Pacelli⁶ 

[1] Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy;Department of Radiology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy;Division of Gynecologic Oncology, Department of Women and Children's Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy;General Surgery and Liver Transplantation, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy;Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy;Università Cattolica del Sacro Cuore, Rome, Italy;

关键词: malignant bowel obstruction (MBO);    peritoneal carcinomatosis (PC);    surgical palliation;    ileostomy;    palliative outcomes;   

DOI  :  10.3389/fsurg.2021.769658

来源: DOAJ

【 摘 要 】

Introduction: Patients with peritoneal metastasis frequently develop malignant bowel obstruction (MBO). Medical palliative management is preferred but often fails. Conversely, the role of palliative surgery remains unclear and debated. This study aims to identify patients who could benefit from invasive surgical interventions and factors associated with successful surgical palliation.Materials and Methods: In this retrospective study, 98 consecutive patients who underwent palliative surgery for MBO over 5 years were reviewed. We evaluate as the primary outcome surgical failure to select patients who could benefit from palliative surgery, avoiding unnecessary surgery. A prognostic score was developed based on a logistic regression model to identify patients at risk of surgical failure. The score was evaluated for overall accuracy by receiver operating characteristic curve analysis.Results: Palliative surgery was achieved in 76 (77.5%) patients. The variables that were found to be significant factors for surgical failure are recurrent disease (P = 0.015), absence of bowel obstruction (P < 0.001), absence of bowel distension (P < 0.001), and mesenteric involvement (P = 0.001) and retraction (P < 0.001). The absence of bowel distension (P = 0.046) and bowel obstruction (P = 0.012) emerged as independent predictors of surgical failure. Carcinomatosis level assessment for peritoneum score, based on these factors, was built to evaluate the risk of surgical failure.Conclusion: Our proposed scoring system might help select patients most likely to benefit from palliative surgery.

【 授权许可】

Unknown