Bleicher Josh, Lambert Laura A, Scaife Courtney L, Colonna Alexander
General Surgery, University of Utah Health, Salt Lake City, Utah, USA.
Surgical Oncology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA.
Trauma Surg Acute Care Open. 2021 Jun 16;6(1):e000755. doi: 10.1136/tsaco-2021-000755. eCollection 2021.
Malignant small bowel obstructions (MSBOs) are one of the most challenging problems surgeons encounter, and evidence-based treatment recommendations are lacking. We hypothesized that current opinions on MSBO management differ between acute care surgeons (ACSs) and surgical oncologists (SOs).
We developed three case scenarios describing patients with previously treated cancer who developed an MSBO. Each case had five to six alternate scenarios, intended to capture the heterogeneity of MSBO presentations. Members of the Society of Surgical Oncology, the American Society of Peritoneal Surface Malignancies, and the Eastern Association for the Surgery of Trauma were asked how likely they would be to offer surgical treatment in each scenario. Responses were analyzed for factors associated with the likelihood surgeons would offer surgical management.
316 surgeons completed the survey: 119 (37.7%) SOs and 197 (62.3%) ACSs. Overall, SOs were nearly twice as likely as ACSs to recommend surgical management. The largest differences between provider groups were seen in patients with an increased metastatic burden. In a patient with MSBO with metastatic colon cancer, both SOs (95.8%) and ACSs (94.4%) were likely or very likely to offer an operation (p=0.587); however, this fell to 91.6% and 77.7%, respectively, when this patient had multiple hepatic metastases (p=0.001). All surgeons were less likely to offer surgery to patients with multiple sites of obstruction, recurrent MSBO, and shorter disease-free intervals.
Opinions on MSBO management differ based on surgeon training and experience. Multidisciplinary management of patients with MSBO should be offered when available and increased emphasis placed on determining optimal management guidelines across specialties.
Level IV Epidemiologic.
恶性小肠梗阻（MSBO）是外科医生面临的最具挑战性的问题之一，目前缺乏基于证据的治疗建议。我们推测，急性外科医生（ACS）和外科肿瘤学家（SO）对MSBO治疗的当前观点存在差异。
我们设计了三个病例场景，描述了患有既往治疗过的癌症且发生MSBO的患者。每个病例有五到六个替代场景，旨在体现MSBO表现的异质性。我们询问了外科肿瘤学会、美国腹膜表面恶性肿瘤学会和东部创伤外科学会的成员，他们在每种场景下提供手术治疗的可能性有多大。分析了与外科医生提供手术治疗可能性相关的因素的回答。
316名外科医生完成了调查：119名（37.7%）SO和197名（62.3%）ACS。总体而言，SO推荐手术治疗的可能性几乎是ACS的两倍。在转移负担增加的患者中，不同医生群体之间的差异最为明显。在患有转移性结肠癌的MSBO患者中（p=0.587），SO（95.8%）和ACS（94.4%）都很可能或非常可能提供手术；然而，当该患者有多处肝转移时，这一比例分别降至91.6%和77.7%（p=0.001）。所有外科医生为有多处梗阻部位、复发性MSBO和较短无病间期的患者提供手术的可能性较小。
基于外科医生的培训和经验，对MSBO治疗的观点存在差异。应在可行时为MSBO患者提供多学科管理，并更加重视确定各专业的最佳管理指南。
IV级流行病学证据。
