New light has been shed on the crucial considerations for treating patients with malignant bowel obstruction.
In a recent comparative effectiveness trial, researchers from the University of Pennsylvania explored the benefits of surgery.
The findings, published in Lancet Gastroenterology & Hepatology, revealed that while surgery did not significantly increase the number of days alive and outside of the hospital, it did provide relief from symptoms associated with the condition.
Dr Robert S. Krouse’s study involved 199 patients who were either randomised to undergo surgery or choose non-surgical options.
The researchers found an adjusted mean difference of 2.9 additional ‘good days’ in the surgical group compared to the non-surgery group, although the difference was not statistically significant.
During the initial hospital stay, six patients succumbed to complications, with five attributed to cancer progression and one to treatment complications related to malignant bowel obstruction.
Patients’ eating ability at week five did not differ between the two treatment approaches.
However, secondary measures indicated that surgery led to improvements in post-hospitalisation malignant bowel obstruction-related symptoms such as nausea, vomiting, constipation, pain and bloating.
Dr Krouse and colleagues believe the study’s evidence could help make challenging decisions about treatment for this patient population.
They suggest that eligible patients, often deemed non-operative, should be offered surgery earlier in their hospital stay to improve gastrointestinal symptoms – even though it may not enhance survival or increase the number of days alive and out of the hospital in the first few months after admission.
According to the authors, patients with malignant bowel obstruction usually have late-stage cancer and often require palliative care to reduce symptoms and pain, with surgery or non-surgical medical management being the primary treatment options.
In a commentary accompanying the study, Dr Jason W Boland and Dr Elaine G Boland from Hull York Medical School and Hull University Teaching Hospitals in England emphasised the importance of respecting individual patient choices.
They noted that patients who had a choice preferred non-surgical options: ‘This study progresses our understanding of these issues, suggesting that survival is overall similar, and that surgery might help some symptoms but that there might be surgical morbidity. These outcomes might be important to different patients, emphasising the need for individualised management.’
The pragmatic comparative effectiveness trial enrolled 221 patients with intra-abdominal or retroperitoneal primary cancer and malignant bowel disease across 30 hospitals and cancer centres in the US, Mexico, Peru and Colombia from May 2015 to April 2020. Of these, 199 were evaluable, with a median age of 60 and 65% being women.
Complications were more common among surgically treated patients compared to those treated non-surgically, with anaemia being the most common grade 3-4 treatment-related complication.
In light of the study’s findings, the researchers suggest the results could be practice-changing for many surgeons, underlining the importance of personalised treatment decisions in managing malignant bowel obstruction.
