Division of Surgical Oncology, UC Davis Cancer Center, 4501 X Street, Suite 3010, Sacramento, CA, 95817, USA.
Department of Public Health Sciences, Division of Biostatistics, UC Davis School of Medicine, 4800 2nd Ave, Suite 2209, Sacramento, CA, 95817, USA.
BMC Cancer. 2018 Nov 26;18(1):1166. doi: 10.1186/s12885-018-5108-9.
Malignant bowel obstruction (MBO) is often a terminal event in end-stage cancer patients. The decision to intervene surgically is complex, given the risk of harm in patients with a limited lifespan. Therefore, we sought to compare clinically meaningful outcomes in MBO patients treated with surgical versus medical management using population-based data.
We performed a retrospective analysis of hospitalized patients with MBO from 2006 to 2010 using the California Office of Statewide Health Planning and Development dataset. Hospital-free days (HFDs) at 30-, 90-, and 180-days were calculated accounting for all hospitalization, emergency department visit, and skilled nursing facility lengths of stay. Adjusted regression models were used to compare HFDs, disposition, complications, in-hospital death, and survival for surgical versus medical MBO cohorts, using inverse probability of treatment weighting with propensity scores.
Of 4576 MBO patients, 3421 (74.8%) were treated medically and 1155 (25.2%) were treated surgically. Surgical patients had higher rates of complications (44.0% vs. 21.3%, p < 0.0001) and in-hospital death (9.5% vs. 3.9%, p < 0.0001) with lower rates of disposition to home (76.3% vs. 89.8%, p < 0.0001). Surgical patients had fewer 30- and 90-day HFDs compared to medical patients (p < 0.01). However, at 180-days, there were no differences in HFDs between treatment groups. There was no difference in overall survival between surgical and medical patients (median 6.5 vs. 6.4 months).
In this population-based analysis, medical management was associated with less hospital utilization at 30- and 90-days, fewer in-hospital deaths, and more frequent discharges to home. These data underscore the potential benefits of medical management for MBO patients at the end-of-life.
恶性肠梗阻（MBO）通常是终末期癌症患者的终末事件。鉴于生存期有限的患者存在伤害风险，手术干预的决策较为复杂。因此，我们试图使用基于人群的数据比较接受手术与药物治疗的 MBO 患者的有临床意义的结局。
我们使用加利福尼亚州全州卫生规划和发展办公室数据集，对 2006 年至 2010 年期间患有 MBO 的住院患者进行了回顾性分析。计算了 30、90 和 180 天时的无住院天数（HFD），并考虑了所有住院、急诊就诊和熟练护理机构的住院时间。使用倾向评分的逆概率治疗加权调整回归模型比较了手术与药物 MBO 队列的 HFD、处置、并发症、住院内死亡和生存情况。
在 4576 例 MBO 患者中，3421 例（74.8%）接受了药物治疗，1155 例（25.2%）接受了手术治疗。手术患者的并发症发生率（44.0% vs. 21.3%，p<0.0001）和住院内死亡率（9.5% vs. 3.9%，p<0.0001）较高，而居家处置率（76.3% vs. 89.8%，p<0.0001）较低。与药物治疗患者相比，手术治疗患者的 30 天和 90 天 HFD 较少（p<0.01）。然而，在 180 天时，两组之间的 HFD 没有差异。手术与药物治疗患者的总生存时间无差异（中位数 6.5 与 6.4 个月）。
在这项基于人群的分析中，与药物治疗相比，手术治疗与 30 天和 90 天的住院利用率降低、住院内死亡减少以及更频繁的居家处置相关。这些数据强调了在生命末期对 MBO 患者进行药物治疗的潜在益处。
