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Gynecologic Oncology

A Prospective Outcomes Analysis of Palliative Procedures Performed for Malignant Intestinal Obstruction Due to Recurrent Ovarian Cancer

^aGynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA; ^bDepartment of Obstetrics and Gynecology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA; ^cDepartment of Surgery, Brown University, Providence, Rhode Island, USA; ^dGeorge Washington University School of Medicine, Washington, DC, USA; ^eSolid Tumor Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA; ^fWashington University, St. Louis, Missouri, USA

Key Words. Palliative surgery • End-of-life care • Recurrent gynecologic cancer

Correspondence: Dennis S. Chi, M.D., 1275 York Ave, Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. Telephone: 212-639-8125; Fax: 212-717-3214; e-mail: gynbreast{at}mskcc.org

Received March 23, 2009; accepted for publication July 15, 2009; first published online in THE ONCOLOGIST Express on August 14, 2009.

Disclosures: Dennis S. Chi: Honoraria: Genzyme; Rebecca Phaëton: None; Thomas J. Miner: None; Steven V. Kardos: None; John P. Diaz: None; Mario M. Leitao, Jr.: None; Ginger Gardner: None; Jae Huh: None; William P. Tew: None; Jason A. Konner: None; Yukio Sonoda: Honoraria: Genzyme; Nadeem R. Abu-Rustum: None; Richard R. Barakat: None; David P. Jaques: None.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the independent peer reviewers.

Objective. To obtain prospective outcomes data on patients (pts) undergoing palliative operative or endoscopic procedures for malignant bowel obstruction due to recurrent ovarian cancer.

Methods. An institutional study was conducted from July 2002 to July 2003 to prospectively identify pts who underwent an operative or endoscopic procedure to palliate the symptoms of advanced cancer. This report focuses on pts with malignant bowel obstruction due to recurrent ovarian cancer. Procedures performed with an upper or lower gastrointestinal (GI) endoscope were considered "endoscopic." All other cases were classified as "operative." Following the procedure, the presence or absence of symptoms was determined and followed over time. All pts were followed until death.

Results. Palliative interventions were performed on 74 gynecologic oncology pts during the study period, of which 26 (35%) were for malignant GI obstruction due to recurrent ovarian cancer. The site of obstruction was small bowel in 14 (54%) cases and large bowel in 12 (46%) cases. Palliative procedures were operative in 14 (54%) pts and endoscopic in the other 12 (46%). Overall, symptomatic improvement or resolution within 30 days was achieved in 23 (88%) of 26 patients, with 1 (4%) postprocedure mortality. At 60 days, 10 (71%) of 14 pts who underwent operative procedures and 6 (50%) of 12 pts who had endoscopic procedures had symptom control. Median survival from the time of the palliative procedure was 191 days (range, 33–902) for those undergoing an operative procedure and 78 days (range, 18–284) for those undergoing an endoscopic procedure.

Conclusion. Patients with malignant bowel obstructions due to recurrent ovarian cancer have a high likelihood of experiencing relief of symptoms with palliative procedures. Although recurrence of symptoms is common, durable palliation and extended survival are possible, especially in those patients selected for operative intervention.