Journal of gastrointestinal oncology · 2026
Non-surgical management of malignant bowel obstruction: strategies and outcomes in inoperable patients.
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Escobar Gil Tomas, Viswanath Pooja, Rosenberg Stephanie, Quazi Mohammed A, Hanson Valeria, Ortega Macias Alan, Tarnower Amy
Аннотация
BACKGROUND: Malignant bowel obstruction (MBO) is a complication of advanced abdominal cancer. Management should be individualized, ranging from surgical or endoscopic interventions to symptom control and comfort measures in inoperable cases. This study examines predictors of survival and disparities in treatment among patients with inoperable MBO.
METHODS: A retrospective cohort study was conducted on 63 patients with MBO treated non-operatively between July 2019 and June 2023 at the University of New Mexico in the Southwestern United States. Of 421 patients screened, exclusions were based on incomplete records or failure to meet clinical and radiological criteria for MBO. Data included demographics, tumor types, treatments, inflammatory markers, and outcomes. Statistical analyses included t-tests, logistic regression, and adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Length of stay (LOS) and survival duration were analyzed using mean differences. Subgroup comparisons identified disparities across gender, ethnicity, and language preferences.
RESULTS: The cohort included 39 females (61.9%) and 24 males (38.1%) with a mean age of 63.2 years [standard deviation (SD) =13.8]. The most common causes of MBO were gastrointestinal (GI) tumors (46%) and gynecologic cancers (34%). The median survival was 25 days, with significant disparities observed. Non-English speakers had higher odds of survival [odds ratio (OR) =5.56, P=0.04], while sepsis at admission was associated with 100% mortality. Elevated C-reactive protein (CRP) (15.85 vs. 8.78 days, P=0.06), steroid use (11.36 vs. 9.92 days, P=0.15), nasogastric (NG) tube placement (10.95 vs. 9 days, P=0.11), and parenteral hydration (12.55 vs. 9.16 days, P=0.37) were associated with longer LOS, though these differences did not reach statistical significance. Higher body mass index (BMI) correlated positively with survival [25.57 (24.0) vs. 24.17 (24.72) kg/m2, P=0.03]. Female patients were more likely to receive NG tubes (OR =3.05, P=0.050) and achieve nonsurgical resolution (OR =3.45, P=0.041) but were less likely to enroll in hospice (OR =0.17, P=0.003). Steroids (22.2%) and octreotide (11.1%) were underutilized despite their role in symptom management.
CONCLUSIONS: Disparities in MBO management highlight gaps in equitable care, particularly gender and language preference. Non-English-speaking patients had a survival advantage, underscoring the importance of culturally tailored care. The underutilization of palliative treatments, such as steroids and octreotide, reveals inconsistencies in guideline adherence. The association of sepsis with 100% mortality reinforces the need for early infection management. Standardized, evidence-based protocols and culturally appropriate care could improve outcomes for this high-risk population.
METHODS: A retrospective cohort study was conducted on 63 patients with MBO treated non-operatively between July 2019 and June 2023 at the University of New Mexico in the Southwestern United States. Of 421 patients screened, exclusions were based on incomplete records or failure to meet clinical and radiological criteria for MBO. Data included demographics, tumor types, treatments, inflammatory markers, and outcomes. Statistical analyses included t-tests, logistic regression, and adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Length of stay (LOS) and survival duration were analyzed using mean differences. Subgroup comparisons identified disparities across gender, ethnicity, and language preferences.
RESULTS: The cohort included 39 females (61.9%) and 24 males (38.1%) with a mean age of 63.2 years [standard deviation (SD) =13.8]. The most common causes of MBO were gastrointestinal (GI) tumors (46%) and gynecologic cancers (34%). The median survival was 25 days, with significant disparities observed. Non-English speakers had higher odds of survival [odds ratio (OR) =5.56, P=0.04], while sepsis at admission was associated with 100% mortality. Elevated C-reactive protein (CRP) (15.85 vs. 8.78 days, P=0.06), steroid use (11.36 vs. 9.92 days, P=0.15), nasogastric (NG) tube placement (10.95 vs. 9 days, P=0.11), and parenteral hydration (12.55 vs. 9.16 days, P=0.37) were associated with longer LOS, though these differences did not reach statistical significance. Higher body mass index (BMI) correlated positively with survival [25.57 (24.0) vs. 24.17 (24.72) kg/m2, P=0.03]. Female patients were more likely to receive NG tubes (OR =3.05, P=0.050) and achieve nonsurgical resolution (OR =3.45, P=0.041) but were less likely to enroll in hospice (OR =0.17, P=0.003). Steroids (22.2%) and octreotide (11.1%) were underutilized despite their role in symptom management.
CONCLUSIONS: Disparities in MBO management highlight gaps in equitable care, particularly gender and language preference. Non-English-speaking patients had a survival advantage, underscoring the importance of culturally tailored care. The underutilization of palliative treatments, such as steroids and octreotide, reveals inconsistencies in guideline adherence. The association of sepsis with 100% mortality reinforces the need for early infection management. Standardized, evidence-based protocols and culturally appropriate care could improve outcomes for this high-risk population.