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08-08-2022 | Surgery | Peritoneal Surface Malignancy

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

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

Published in: Annals of Surgical Oncology | Issue 13/2022

Abstract

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.

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Title: Natural History and Management of Small-Bowel Obstruction in Patients After Cytoreductive Surgery and Intraperitoneal Chemotherapy
Authors: Eyal Mor, MD
Shanie Shemla, MD
Dan Assaf, MD
Shachar Laks, MD
Haggai Benvenisti, MD
David Hazzan, MD
Mai Shiber, MD
Einat Shacham-Shmueli, MD
Ofer Margalit, MD
Naama Halpern, MD
Ben Boursi, MD
Tamar Beller, MD
Daria Perelson, MD
Ofer Purim, MD
Douglas Zippel, MD
Almog Ben-Yaacov, MD
Aviram Nissan, MD
Mohammad Adileh, MD
Publication date: 08-08-2022
Publisher: Springer International Publishing
Keywords: Surgery
Cytostatic Therapy
Peritonectomy
Published in: Annals of Surgical Oncology / Issue 13/2022
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-022-12370-x

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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