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Malignant bowel blockages are common in patients who have advanced abdominal tumors, especially cancers of the ovaries or colon, and a new clinical trial suggests surgery should be offered to them sooner rather than later.
“We knew enrolling patients in the hospital with this acute issue and advanced cancer would be difficult, but the questions are of great importance to clinicians, patients, and families,” said principal investigator Dr. Robert Krouse, a professor at the University of Pennsylvania Perelman School of Medicine and chief of surgery at the Veterans Affairs Medical Center in Philadelphia.
“Based on the results, we believe surgically eligible patients with MBO [major bowel obstructions] should be offered an operation earlier in their hospital stay to improve their symptoms, even though these results suggest it will not increase their number of days alive and out of the hospital,” Krouse said.
Bowel obstructions can be caused directly by tumors or by adhesions or other complications of surgery or radiation treatment.
These obstructions are not only potentially life-threatening, but also cause significant suffering, including vomiting, pain and constipation. Patients with MBO are typically facing end-stage cancer, and are receiving palliative care meant to improve their quality of life and reduce symptoms and pain.
Doctors treating MBO have a choice of surgery or medication.
This trial, to look at which option was best, was done at institutions across the United States, as well as in Mexico, Peru and Colombia.
The trial, led by the SWOG Cancer Research Network, included 199 patients with MBO, all of whom were considered surgery candidates.
Patients were offered a chance to be randomly assigned to a treatment type. About 25% did so. Others instead decided with their doctor which treatment to choose. About 40% of these participants chose surgery.
To assess the outcome, researchers tracked "good days" when each patient was alive and out of the hospital during their first three months after registering for the trial.
The number of good days during that time did not vary significantly between the two methods for treating MBO. Patients' ability to eat at week five was also the same.
But secondary measures suggested that surgery resulted in improvements in MBO-related symptoms. At week 4, surgery patients had better symptom scores for vomiting, constipation, nausea and pain than patients who were treated non-surgically. Those who had surgery also reported fewer MBO-related symptoms after leaving the hospital.
“We are continuing to analyze the data to allow us to make recommendations to clinicians regarding the optimal operations and other quality of life factors that may be impacted by the type of treatment received,” Krouse said in a SWOG news release. “Our network of institutions and investigators will allow us to examine other important question in this population of cancer survivors."
Study findings were published Aug. 1 in The Lancet Gastroenterology & Hepatology.
SOURCE: SWOG Cancer Research Network, news release, Aug. 1, 2023
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