The aim of this study was to evaluate the outcomes of patients with a gynecological malignancy who received palliative care with and without surgical procedures for malignant bowel obstruction (MBO) and to explore prognostic factors to aid the selection of patients who would benefit from palliative surgery. Medical records of patients with MBO due to a gynecological malignancy treated at our institute between 2005 and 2010 were reviewed. Successful palliation following surgery was defined as the ability to tolerate solid food for at least 60 days. Clinical variables were analyzed using Chi-square or Fisher’s exact tests. Survival was evaluated using the Kaplan-Meier method and log-rank test. A total of 53 cases were identified; 20 had bowel surgery for MBO as a palliative procedure and 33 did not. Colostomy was performed in 11 (55%) of 20 patients and ileostomy was performed in 7 (35%). The postoperative morbidity was 35% and mortality within 30 days was 5%. Successful palliation following surgery was achieved in 14 (70%) of 20 cases with a median period of 146 days (range, 61–294). Survival following the diagnosis of MBO was longer in cases with surgery than those without (median survival time, 146 versus 69 days; P<0.0001). Although age, presence of ascites, laboratory values and types of prior anticancer therapy were not significantly different, a longer interval from last anticancer therapy to diagnosis of MBO was observed in patients who underwent surgery compared with those who did not (median, 57 versus 30 days; P<0.05), as well as superior performance status. Among the patients with surgery, the interval was also longer in patients with successful palliation compared with those without (median, 83 versus 32 days; P<0.05). The palliative benefit of surgery for MBO in selected patients with gynecological malignancy was observed. The interval from last anticancer therapy to diagnosis of MBO may serve as a prognostic factor when considering surgical intervention.
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机译：这项研究的目的是评估接受或不接受手术治疗恶性肠梗阻（MBO）的姑息治疗的妇科恶性肿瘤患者的结局，并探讨预后因素，以帮助选择将从姑息性手术中受益的患者。回顾了我院2005年至2010年间因妇科恶性肿瘤而导致的MBO患者的病历。手术后成功缓解疼痛定义为耐受固体食物至少60天的能力。临床变量使用卡方检验或Fisher精确检验进行了分析。使用Kaplan-Meier方法和对数秩检验评估生存率。共发现53例； 20例因姑息性肠切除术而接受了肠手术，而33例则没有。 20例患者中有11例（55％）进行了结肠造口术，而7例（35％）进行了回肠造口术。术后发病率为35％，30天内死亡率为5％。 20例中有14例（70％）手术后成功缓解了疼痛，中位时间为146天（范围61-294）。接受MBO诊断的患者在接受手术治疗后的生存时间比未接受MBO的患者要长（中位生存时间分别为146天和69天； P <0.0001）。尽管年龄，腹水的存在，实验室值和既往抗癌治疗的类型没有显着差异，但与未接受手术的患者相比，接受最后手术的患者从最后一次抗癌治疗到诊断为MBO的间隔更长（中位数为57 vs 30天； P <0.05），以及优异的表现状态。在接受手术治疗的患者中，成功完成安慰剂治疗的患者的间隔时间也比未接受手术治疗的患者更长（中位数为83天对32天； P <0.05）。在选定的妇科恶性肿瘤患者中观察到手术治疗MBO的姑息性益处。在考虑手术干预时，从上一次抗癌治疗到MBO诊断的间隔可能是预后因素。
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