1. Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction
- Author
-
Thomas M. Drake, Matthew J. Lee, Adele E. Sayers, John Abercrombie, Austin Acheson, Derek Alderson, Iain Anderson, Mike Bradburn, Michael Davies, Zaed Hamady, Daniel Hind, Marianne Hollyman, Sarah Hare, Ellen Lee, John Northover, Christopher Lewis, Paul J. Marriott, Nick Maynard, Malcolm McFall, Aravinth Muragananthan, David Murray, Pritam Singh, Gillian Tierney, Azmina Verjee, Ciaran Walsh, Jonathan RL. Wild, Timothy Wilson, S. Abbott, Y. Abdulaal, S. Afshar, M. Akhtar, D. Anderson, S. Appleton, D. Bandyopadhyay, G. Bashir, N. Behar, S. Bhandari, G. Branagan, R. Boulton, C. Borg, G. Bouras, J. Boyle, H. Brewer, L. Brown, C. Briggs, M. Cartmell, S. Chan, N. Chandratreya, P. Conaghan, J. Cornish, D. Cotton, P. Coyne, J. Crozier, T. Cook, P. Cunha, N. Curtis, A. Day, S. Dayal, R. Dennis, P. Dent, H. Dowson, R. Fallaize, S. Farag, M. El Farran, G. Faulkner, P. Giordano, T. Grey, V. Halahakoon, J. Hannay, A. Harikrishnan, S. Holtham, P. Hawkin, C. Hall, L. Hancock, J. Hartley, F. Howse, R. Kallam, G. Kakaniaris, S. Kelly, S. Lockwood, D. Leinhardt, B. Levy, R. Lal, T. Lazim, J. Lund, R. Lunevicius, P. Mathur, K. Maude, D. McArthur, B. McIlroy, A. Miles, S. Moug, M. Mondragon-Pritchard, D. Messenger, M. Mullan, A. Myers, K. Muhammad, C. Mason, J. Sarveswaran, V. Shatkar, B. Singh, B. Skelly, S. Subramonia, M. Swinscoe, B. Thava, C. Thorn, S. Panagiotopoulos, P. Patel, J. Phillips, I. Peristerakis, A. Qureshi, M. Saunders, P. Shah, A. Sheel, S. Siddiqui, P. Skaife, N. Smart, I. Smith, L. Stevenson, N. Stylianides, J. Steinke, B. Stubbs, R. Thompson, M. Varcada, D. Vimalachandran, I. Virlos, J. Watfah, N. Watson, M. Walker, N. Ventham, H. West, J. Wilson, S. Wijeyekoon, J. Ah-Chuen, T. Ahmed, F. Akram, E. Aldred, A. Ali, M. Aly, A. Amajuoyi, V. Amin, A. Andreou, A. Ansari, R. Ardley, F. Arshad, O. Ashour, A. Asour, F. Ayoub, H. Azeem, B. Azhar, C. Baillie, J. Barker, B. Barkham, R. Baron, J. Barrie, E. Barry-Yarrow, N. Battersby, G. Bazoua, C. Berger, S. Bhasin, S. Biggs, C. Bisset, N. Blencowe, A. Boddy, C. Boereboom, M. Bogdan, R. Bogle, P. Bohra, H. Bolkan, M. Boyer, J. Broadhurst, E. Brown, J. Brown, K. Burns, K. Butcher, C. Capper, T. Cash, J. Chapman, S. Chapman, A. Charalabopoulos, C. Cheek, S. Chok, W. Choong, J. Chowdhury, P. Coe, G. Conn, N. Cook, S. Cooper, C. Cox, R. Crook, G. Cuffolo, L. da Silva, B. Das, M. Davenport, J. Davies, T. Davies, S. Dean, G. Demetriou, F. Dengu, H. Dent, G. Di Benedetto, S. Dindyal, E. Donnelly, E. Douka, C. Downham, H. Edent, K. Edgerton, M. El-Sharif, O. Elamin, N. Elsaid, J. Evans, M. Evans, R. Ewe, A. Ewing, H. Ferguson, O. Fisher, J. Fletcher, A. Forouzanfar, A. Foster, R. Fox, N. Francis, V. Fretwell, D. Fung, E. Gammeri, J. Garnham, A. Geraghty, A. Gilbert, M. Gill, M. Gillespie, J. Glasbey, A. Golder, N. Green, E. Groundwater, T. Grove, H. Habib, J. Haddow, C. Halkias, A. Hampson, T. Hanna, R. Harries, K. Harvey, J. Hawkins, R. Healy, R. Heartshorne, S. Heller, L. Hendra, P. Herrod, N. Heywood, G. Hicks, P. Ng, C. Hope, P. Hopley, T. Hossain, S. Hossaini, T. Hubbard, A. Humphreys, H. Ikram, M. Ioannis, M. Iqbal, J. Jatania, P. Jenkinson, S. Jokhan, A. Jones, C. Jones, L. Jones, H. Joshi, K. Joshi, M. Joy, P. Jull, E. Kane, R. Kanitkar, S. Kauser, F. Kazmi, M. Kedrzycki, J. Kendall, T. Khan, G. King, A. Kisiel, C. Kitsis, I. Kolawole, S. Kosasih, A. Kosti, A. Kotb, A. Lau, G. Lafaurie, A. Lazzaro, R. Lefroy, H. Lennon, K. Leong, E. Lim, J. Lim, S. Lindley, D. Liu, P. Lloyd, D. Locker, C. Lowe, A. Lunt, S. Lutfi, A. Luther, S. Luwemba, P. Mahankali-Rao, D. Mai, S. Majid, A. Malik, N. Manu, R. Mapara, C. Martin, J. Martin, L. Massey, J. Mathias, S. McCain, S. McCluney, A. McNair, P. Mekhail, J. Merchant, L. Merker, S. Mir, P. Mistry, V. Miu, M. Moat, E. Mohamed, I. Mohamed, N. Moore, L. Moretti, H. Morris, T. Morrison, J. Moss, D. Mountford, R. Moynihan, D. Muldoon-Smith, J. Mulholland, E. Murgitroyd, K. Murugaiyan, I. Mykoniatis, G. Nana, T. Nash, A. Nassar, R. Newton, K. Nguyen, F. Nicholas, M. Noor, J. Nowers, C. Nugent, A. Nunn, J. O'Callaghan, R. O'Hara, A. O'Neill, J. Olivier, D. Osei-Bordom, L. Osgood, B. Panchasara, R. Parks, H. Patel, K. Pawelec, C. Payne, K. Pearson, G. Perin, B. Petronio, L. Phelan, C. Pisaneschi, J. Pitt, L. Ponchietti, A. Powell, A. Powell-Chandler, N. Pranesh, V. Proctor, N. Qureshi, M. Rahman, Z. Rai, S. Ramcharan, K. Rangarajan, M. Rashid, H. Reader, A. Rehman, S. Rehan, C. Rengifo, N. Richardson, A. Robinson, D. Robinson, B. Rossi, F. Rutherford, I. Sadien, T. Saghir, K. Sahnan, G. Salahia, B. Scott, K. Scott, A. Seager, S. Seal, E. Sezen, F. Shaban, M. Shahmohammadi, A. Shamsiddinova, S. Shankar, A. Sharpe, T. Shields, M. Shinkwin, J. Shurmer, A. Siddika, R. Simson, S. Singh, J. Sivaraj, A. Skinner, C. Smart, F. Smith, R. Smith, A. Sreedhar, E. Stewart-Parker, M. Stott, N. Symons, T. Taj, J. Tam, K. Tan, S. Tani, D. Tao, K. Thippeswamy, C. Thomas, E. Thompson, C. Thompson-Reil, F. Tongo, G. Toth, A. Turnbull, J. Turnbull, T. Wade, A. Wafi, K. Waite, N. Walker, T. Walker, U. Walsh, S. Wardle, R. Warner, J. Watt, J. Watts, J. Wayman, C. Weegenaar, M. West, M. Whyler, L. Whitehurst, M. Wiggans, G. Williams, R. Williams, A. Williamson, J. Williamson, A. Winter, L. Wolpert, J. Wong, G. van Boxel, E. Yeap, S. Zaman, B. Zappa, D. Zosimas, O. Anderson, A. Athem, M. Athersmith, T. Badenoch, S. Barker, S. Bellam, T. Boam, M. Boland, L. Blake, O. Brown, M. Butler, B. Byrne, L. Campbell, M. Chow, K. Da Costa, J. Cutting, M. Deputy, L. Devoto, P. Doody, N. Ekpete, M. Eljaafari, K. Exarchou, M. Faoury, E. Farinella, C. Gill, M. Goh, T. Gregoir, S. Growcott, S. Gunasekaran, G. Harris, R. Heard, B. Hobson, N. Iqbal, R. Jain, P. Kang, M. Khan, S. Korambayil, S. Kouris, K. Kshatriya, S. Kumar, K. Lee, S. Mahroof, K. Malik, K. Mann, S. Mansour, R. Martin, S. McKay, N. McKinley, D. McWhirter, K. Mellor, A. Mishra, K. Mockford, V. Morrison-Jones, C. Ng, R. Nunn, S. O'Neill, O. Oke, N. Obeid, R. Patel, S. Patel, K. Plunkett-Reed, M. Pouzi, S. Pywell, E. Richards, P. Sinclair, N. Slim, G. Spence, M. Swinkin, W. Tahir, K. Takacs, N. Tanner, M. Taylor, C. Valero, M. Venn, M. Venza, T. Yeong, and Nicola S. Fearnhead
- Subjects
Male ,medicine.medical_specialty ,Colorectal cancer ,030230 surgery ,Malignancy ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,Intestinal Neoplasms ,Intestine, Small ,Humans ,Medicine ,Prospective Studies ,Aged ,business.industry ,Mortality rate ,Hazard ratio ,Cancer ,General Medicine ,medicine.disease ,United Kingdom ,Bowel obstruction ,Oncology ,Abdominal Neoplasms ,030220 oncology & carcinogenesis ,Cohort ,Female ,Surgery ,business ,Intestinal Obstruction ,Cohort study - Abstract
Introduction\ud \ud Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction.\ud \ud \ud \ud Methods\ud \ud A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori.\ud \ud \ud \ud Results\ud \ud 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity.\ud \ud \ud \ud Conclusions\ud \ud Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups.
- Published
- 2019
- Full Text
- View/download PDF