Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction

Abstract

Introduction

Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction.

Methods

A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori.

Results

205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity.

Conclusions

Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups.

Metadata

Authors/Creators:	Drake, TM Lee, MJ https://orcid.org/0000-0001-9971-1635 Sayers, AE Abercrombie, J Acheson, A Alderson, D Anderson, I Bradburn, M https://orcid.org/0000-0002-3783-9761 Davies, M Hamady, Z Hind, D https://orcid.org/0000-0002-6409-4793 Hollyman, M Hare, S Lee, E Northover, J Lewis, C Marriott, PJ Maynard, N McFall, M Muragananthan, A Murray, D Singh, P Tierney, G Verjee, A Walsh, C Wild, JRL Wilson, T Abbott, S Abdulaal, Y Afshar, S Akhtar, M Anderson, D Appleton, S Bandyopadhyay, D Bashir, G Behar, N Bhandari, S Branagan, G Boulton, R Borg, C Bouras, G Boyle, J Brewer, H Brown, L Briggs, C Cartmell, M Chan, S Chandratreya, N Conaghan, P Cornish, J Cotton, D Coyne, P Crozier, J Cook, T Cunha, P Curtis, N Day, A Dayal, S Dennis, R Dent, P Dowson, H Fallaize, R Farag, S El Farran, M Faulkner, G Giordano, P Grey, T Halahakoon, V Hannay, J Harikrishnan, A Holtham, S Hawkin, P Hall, C Hancock, L Hartley, J Howse, F Kallam, R Kakaniaris, G Kelly, S Lockwood, S Leinhardt, D Levy, B Lal, R Lazim, T Lund, J Lunevicius, R Mathur, P Maude, K McArthur, D McIlroy, B Miles, A Moug, S Mondragon-Pritchard, M Messenger, D Mullan, M Myers, A Muhammad, K Mason, C Sarveswaran, J Shatkar, V Singh, B Skelly, B Subramonia, S Swinscoe, M Thava, B Thorn, C Panagiotopoulos, S Patel, P Phillips, J Peristerakis, I Qureshi, A Saunders, M Shah, P Sheel, A Siddiqui, S Skaife, P Smart, N Smith, I Stevenson, L Stylianides, N Steinke, J Stubbs, B Thompson, R Varcada, M Vimalachandran, D Virlos, I Watfah, J Watson, N Walker, M Ventham, N West, H Wilson, J Wijeyekoon, S Ah-Chuen, J Ahmed, T Akram, F Aldred, E Ali, A Aly, M Amajuoyi, A Amin, V Andreou, A Ansari, A Ardley, R Arshad, F Ashour, O Asour, A Ayoub, F Azeem, H Azhar, B Baillie, C Barker, J Barkham, B Baron, R Barrie, J Barry-Yarrow, E Battersby, N Bazoua, G Berger, C Bhasin, S Biggs, S Bisset, C Blencowe, N Boddy, A Boereboom, C Bogdan, M Bogle, R Bohra, P Bolkan, H Boyer, M Broadhurst, J Brown, E Brown, J Burns, K Butcher, K Capper, C Cash, T Chapman, J Chapman, S Charalabopoulos, A Cheek, C Chok, S Choong, W Chowdhury, J Coe, P Conn, G Cook, N Cooper, S Cox, C Crook, R Cuffolo, G da Silva, L Das, B Davenport, M Davies, J Davies, T Dean, S Demetriou, G Dengu, F Dent, H Di Benedetto, G Dindyal, S Donnelly, E Douka, E Downham, C Edent, H Edgerton, K El-Sharif, M Elamin, O Elsaid, N Evans, J Evans, M Ewe, R Ewing, A Ferguson, H Fisher, O Fletcher, J Forouzanfar, A Foster, A Fox, R Francis, N Fretwell, V Fung, D Gammeri, E Garnham, J Geraghty, A Gilbert, A Gill, M Gillespie, M Glasbey, J Golder, A Green, N Groundwater, E Grove, T Habib, H Haddow, J Halkias, C Hampson, A Hanna, T Harries, R Harvey, K Hawkins, J Healy, R Heartshorne, R Heller, S Hendra, L Herrod, P Heywood, N Hicks, G Ng, P Holtham, S Hope, C Hopley, P Hossain, T Hossaini, S Hubbard, T Humphreys, A Ikram, H Ioannis, M Iqbal, M Jatania, J Jenkinson, P Jokhan, S Jones, A Jones, C Jones, L Joshi, H Joshi, K Joy, M Jull, P Kakaniaris, G Kane, E Kanitkar, R Kauser, S Kazmi, F Kedrzycki, M Kendall, J Khan, T King, G Kisiel, A Kitsis, C Kolawole, I Kosasih, S Kosti, A Kotb, A Lau, A Lafaurie, G Lazim, T Lazzaro, A Lefroy, R Leinhardt, D Lennon, H Leong, K Lim, E Lim, J Lindley, S Liu, D Lloyd, P Locker, D Lowe, C Lunt, A Lutfi, S Luther, A Luwemba, S Mahankali-Rao, P Mai, D Majid, S Malik, A Manu, N Mapara, R Martin, C Martin, J Massey, L Mathias, J McCain, S McCluney, S McNair, A Mekhail, P Merchant, J Merker, L Mir, S Mistry, P Miu, V Moat, M Mohamed, E Mohamed, I Moore, N Moretti, L Morris, H Morrison, T Moss, J Mountford, D Moynihan, R Muldoon-Smith, D Mulholland, J Murgitroyd, E Murugaiyan, K Mykoniatis, I Nana, G Nash, T Nassar, A Newton, R Ng, P Nguyen, K Nguyen, K Nicholas, F Noor, M Nowers, J Nugent, C Nunn, A O'Callaghan, J O'Hara, R O'Neill, A Olivier, J Osei-Bordom, D Osgood, L Panchasara, B Parks, R Patel, H Pawelec, K Payne, C Pearson, K Perin, G Petronio, B Phelan, L Pisaneschi, C Pitt, J Ponchietti, L Powell, A Powell-Chandler, A Pranesh, N Proctor, V Qureshi, N Rahman, M Rai, Z Ramcharan, S Rangarajan, K Rashid, M Reader, H Rehman, A Rehan, S Rengifo, C Richardson, N Robinson, A Robinson, D Rossi, B Rutherford, F Sadien, I Saghir, T Sahnan, K Salahia, G Scott, B Scott, K Seager, A Seal, S Sezen, E Shaban, F Shah, P Shahmohammadi, M Shamsiddinova, A Shankar, S Sharpe, A Shields, T Shinkwin, M Shurmer, J Siddika, A Simson, R Singh, S Sivaraj, J Skinner, A Smart, C Smith, F Smith, R Sreedhar, A Stewart-Parker, E Stott, M Stubbs, B Symons, N Taj, T Tam, J Tan, K Tani, S Tao, D Thippeswamy, K Thomas, C Thompson, E Thompson-Reil, C Tongo, F Toth, G Turnbull, A Turnbull, J Wade, T Wafi, A Waite, K Walker, N Walker, T Walsh, U Wardle, S Warner, R Watt, J Watts, J Wayman, J Weegenaar, C West, M Whyler, M Whitehurst, L Wiggans, M Williams, G Williams, R Williamson, A Williamson, J Winter, A Wolpert, L Wong, J van Boxel, G Yeap, E Zaman, S Zappa, B Zosimas, D Anderson, O Athem, A Athersmith, M Badenoch, T Barker, S Bellam, S Boam, T Boland, M Blake, L Brown, O Butler, M Byrne, B Campbell, L Chow, M Da Costa, K Cutting, J Deputy, M Devoto, L Doody, P Ekpete, N Eljaafari, M Exarchou, K Faoury, M Farinella, E Gill, C Goh, M Gregoir, T Growcott, S Gunasekaran, S Harris, G Heard, R Hobson, B Iqbal, N Jain, R Kang, P Khan, M Korambayil, S Kouris, S Kshatriya, K Kumar, S Lee, K Mahroof, S Malik, K Mann, K Mansour, S Martin, R McKay, S McKinley, N McWhirter, D Mellor, K Mishra, A Mockford, K Morrison-Jones, V Ng, C Nunn, R O'Neill, S Oke, O Obeid, N Patel, R Patel, S Plunkett-Reed, K Pouzi, M Pywell, S Richards, E Sinclair, P Slim, N Spence, G Swinkin, M Tahir, W Takacs, K Tanner, N Taylor, M Valero, C Venn, M Venza, M Yeong, T Fearnhead, NS
Copyright, Publisher and Additional Information:	© 2019 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. This is an author produced version of a paper subsequently published in European Journal of Surgical Oncology. Uploaded in accordance with the publisher's self-archiving policy. Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Keywords:	Cancer; Outcomes; Small bowel obstruction; Abdominal Neoplasms; Aged; Female; Humans; Intestinal Neoplasms; Intestinal Obstruction; Intestine, Small; Male; Postoperative Complications; Prospective Studies; United Kingdom
Dates:	Accepted: 6 July 2019 Published (online): 9 July 2019 Published: December 2019
Institution:	The University of Sheffield
Academic Units:	The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research
Depositing User:	Symplectic Sheffield
Date Deposited:	11 Dec 2020 07:21
Last Modified:	11 Dec 2020 07:21
Status:	Published
Publisher:	Elsevier
Refereed:	Yes
Identification Number:	https://doi.org/10.1016/j.ejso.2019.07.014
Related URLs:	PubMed URL

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Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction

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