From the Departments of Surgical Oncology (Ayabe, Badgwell), University of Texas MD Anderson Cancer Center, Houston, TX.
Symptom Research (Mendoza, Williams), University of Texas MD Anderson Cancer Center, Houston, TX.
J Am Coll Surg. 2023 Mar 1;236(3):514-522. doi: 10.1097/XCS.0000000000000498. Epub 2022 Dec 8.
Gastrointestinal obstruction is the most common indication for palliative surgical consultation. We sought to assess patient-reported outcomes and survival after surgical and nonsurgical treatment of malignant bowel obstruction.
This was a prospective observational study enrolling patients with advanced malignancy who underwent surgical consultation at a tertiary cancer center. Patient-reported outcomes were evaluated using a previously validated inventory, the MD Anderson Symptom Inventory-Gastrointestinal Obstruction (MDASI-GIO), administered at enrollment and 7 other time points for up to 90 days.
We enrolled 125 patients, of whom 37 underwent surgery and 88 did not. Patients treated nonsurgically were more likely to have carcinomatosis on imaging (71% vs 49%, p = 0.02). Pain medicine, palliative care, and chaplaincy consultations occurred in 17%, 30%, and 15% of patients within the first month of enrollment. Higher mean symptom scores were noted by surgical patients, although the only single scores with effect sizes 0.5 or greater were symptom interference with general activity and work. The composite score for interference in work, activity, and walking had the largest effect size at -0.37, indicating greater interference in patients undergoing surgery. Patients selected for surgery had extended overall survival (median 15 vs 3 months, p < 0.01). Carcinomatosis, palliative care evaluation, and venting gastrostomy tube were associated with increased risk of death, and ability to receive subsequent chemotherapy and surgical management were positive prognostic indicators.
In this first study evaluating patient-reported outcomes after treatment for malignant bowel obstruction, we found that selection for surgical treatment was associated with improved survival, but also more symptom interference in general activities and work. These results may be useful in palliative surgical decision-making and informing patients during consultation for malignant bowel obstruction.
胃肠道梗阻是姑息性手术咨询最常见的指征。我们旨在评估恶性肠梗阻患者经手术和非手术治疗后的患者报告结局和生存情况。
这是一项前瞻性观察性研究，纳入在三级癌症中心接受姑息性外科咨询的晚期恶性肿瘤患者。采用先前验证的 MD 安德森症状量表-胃肠道梗阻（MDASI-GIO）评估患者报告的结局，在入组时以及之后的 7 个其他时间点进行评估，最长可达 90 天。
我们共纳入 125 例患者，其中 37 例行手术，88 例不行手术。影像学检查提示存在癌性转移的患者更可能选择非手术治疗（71% vs 49%，p = 0.02）。入组后 1 个月内，17%、30%和 15%的患者接受了止痛药物、姑息治疗和牧师咨询。手术组患者的平均症状评分较高，但只有总活动和工作干扰这两个单项评分的效应量为 0.5 或更大。工作、活动和行走干扰的综合评分效应量最大，为-0.37，表明手术组患者的干扰更大。选择手术的患者具有更长的总生存期（中位数 15 个月 vs 3 个月，p < 0.01）。癌性转移、姑息治疗评估和胃肠造口管引流与死亡风险增加相关，而能够接受后续化疗和手术治疗是阳性预后指标。
在这项首次评估恶性肠梗阻治疗后患者报告结局的研究中，我们发现选择手术治疗与生存改善相关，但也与一般活动和工作的更多症状干扰相关。这些结果可能有助于姑息性手术决策，并为恶性肠梗阻患者咨询时提供信息。
