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Natural History and Management of Small-Bowel Obstruction in Patients After Cytoreductive Surgery and Intraperitoneal Chemotherapy

  • Peritoneal Surface Malignancy
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Abstract

Background

Small-bowel obstruction (SBO) after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a common complication associated with re-admission that may alter patients’ outcomes. Our aim was to characterize and investigate the impact of bowel obstruction on patients’ prognosis.

Methods

This was a retrospective analysis of patients with SBO after CRS/HIPEC (n = 392). We analyzed patients’ demographics, operative and perioperative details, SBO re-admission data, and long-term oncological outcomes.

Results

Out of 366 patients, 73 (19.9%) were re-admitted with SBO. The cause was adhesive in 42 (57.5%) and malignant (MBO) in 31 (42.5%). The median time to obstruction was 7.7 months (range, 0.5–60.9). Surgical intervention was required in 21/73 (28.7%) patients. Obstruction eventually resolved (spontaneous or by surgical intervention) in 56/73 (76.7%) patients. Univariant analysis identified intraperitoneal chemotherapy agents: mitomycin C (MMC) (HR 3.2, p = 0.003), cisplatin (HR 0.3, p = 0.03), and doxorubicin (HR 0.25, p = 0.018) to be associated with obstruction-free survival (OFS). Postoperative complications such as surgical site infection (SSI), (HR 2.2, p = 0.001) and collection (HR 2.07, p = 0.015) were associated with worse OFS. Multivariate analysis maintained MMC (HR 2.9, p = 0.006), SSI (HR 1.19, p = 0.001), and intra-abdominal collection (HR 2.19, p = 0.009) as independently associated with OFS. While disease-free survival was similar between the groups, overall survival (OS) was better in the non-obstruction group compared with the obstruction group (p = 0.03).

Conclusions

SBO after CRS/HIPEC is common and complex in management. Although conservative management was successful in most patients, surgery was required more frequently in patients with MBO. Patients with SBO demonstrate decreased survival.

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Authors and Affiliations

  1. The Department of General and Oncological Surgery - Surgery C, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel

    Eyal Mor MD, Shanie Shemla MD, Dan Assaf MD, Shachar Laks MD, Haggai Benvenisti MD, David Hazzan MD, Mai Shiber MD, Douglas Zippel MD, Almog Ben-Yaacov MD, Aviram Nissan MD & Mohammad Adileh MD

  2. The Department of Oncology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel

    Einat Shacham-Shmueli MD, Ofer Margalit MD, Naama Halpern MD, Ben Boursi MD & Tamar Beller MD

  3. The Department of Anesthesiology, Sheba Medical Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel

    Daria Perelson MD

  4. The Department of Oncology, Assuta Ashdod Public Hospital, Affiliated with the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel, Ashdod, Israel

    Ofer Purim MD

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Mor, E., Shemla, S., Assaf, D. et al. Natural History and Management of Small-Bowel Obstruction in Patients After Cytoreductive Surgery and Intraperitoneal Chemotherapy. Ann Surg Oncol 29, 8566–8579 (2022). https://doi.org/10.1245/s10434-022-12370-x

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