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Management of Malignant Small Bowel Obstruction: Is Intestinal Bypass Effective Palliation?

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background/Purpose

Malignant small bowel obstruction (mSBO) is a common consequence of advanced malignancies. Surgical consultation is common, however data on the outcomes following an operation are lacking. We investigated a specific operative approach—intestinal bypass—to determine the outcomes associated with this intervention.

Methods

Patients with a preoperative diagnosis of mSBO who underwent intestinal bypass between 2015 and 2021 were included. Isolated colonic obstruction was excluded as was gastric outlet obstruction. Perioperative and postoperative outcomes were measured, including complications, overall survival, return to oral intake, and return to intended oncologic therapy. Patients were additionally grouped as to whether the operation was performed as elective or as inpatient.

Results

Overall, 55 patients were identified, with a mean age of 61.2 ± 14 years. The most common primary malignancy was colorectal cancer (65.5%) and 80% of patients had a preoperative diagnosis of metastatic disease. Small bowel to colon was the most common bypass procedure (51%). Severe complications occurred in 25.5% of patients with three in-hospital mortalities (5.5%). Survival rates at 30, 90, and 180 days were 91%, 80%, and 62%, respectively. The majority of patients were discharged to home (85.5%) and were tolerating an oral diet (74.6%). Twenty-seven patients (49.1%) returned to some form of oncologic treatment.

Conclusions

Patients with mSBO face a potentially terminal condition. In this study, approximately 75% of patients who underwent intestinal bypass were able to regain the ability to eat, and 49% returned to oncologic therapy. Although retrospective, these data suggest the approach is efficacious for palliation of this difficult sequela of advanced cancer.

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Authors and Affiliations

  1. Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA

    Meagan Read MD, Benjamin D. Powers MS, MD, Jose M. Pimiento MD, Danielle Laskowitz PA-C, Erin Mihelic PA-C, Iman Imanirad MD, Sophie Dessureault MD, PhD, Seth Felder MD & Sean P. Dineen MD

  2. Department of Surgery, Morsani College of Medicine, Tampa, FL, USA

    Meagan Read MD & Sophie Dessureault MD, PhD

  3. Department of Oncologic Sciences, Morsani College of Medicine, Tampa, FL, USA

    Benjamin D. Powers MS, MD, Jose M. Pimiento MD, Sophie Dessureault MD, PhD, Seth Felder MD & Sean P. Dineen MD

  4. Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA

    Benjamin D. Powers MS, MD

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  1. Meagan Read MD
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Correspondence to Sean P. Dineen MD.

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Disclosure

Meagan Read, Benjamin D. Powers, Jose M. Pimiento, Danielle Laskowitz, Erin Mihelic, Iman Imanirad, Sophie Dessureault, Seth Felder, and Sean P. Dineen declare no conflicts of interest.

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Read, M., Powers, B.D., Pimiento, J.M. et al. Management of Malignant Small Bowel Obstruction: Is Intestinal Bypass Effective Palliation?. Ann Surg Oncol 29, 6980–6987 (2022). https://doi.org/10.1245/s10434-022-12204-w

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  • DOI: https://doi.org/10.1245/s10434-022-12204-w

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