Prognostic Factors for Surgical Failure in Malignant Bowel Obstruction and Peritoneal Carcinomatosis

Introduction: Patients with peritoneal metastasis frequently develop malignant bowel obstruction (MBO). Medical palliative management is preferred but often fails. Conversely, the role of palliative surgery remains unclear and debated. This study aims to identify patients who could benefit from inva...

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Autores principales:	Claudio Lodoli, Marcello Covino, Miriam Attalla El Halabieh, Francesco Santullo, Andrea Di Giorgio, Carlo Abatini, Stefano Rotolo, Elena Rodolfino, Francesco Giovinazzo, Anna Fagotti, Giovanni Scambia, Francesco Franceschi, Fabio Pacelli
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	malignant bowel obstruction (MBO) peritoneal carcinomatosis (PC) surgical palliation ileostomy palliative outcomes Surgery RD1-811
Acceso en línea:	https://doaj.org/article/c803090fc57f49e9acae31fda9b40c0e
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spelling	oai:doaj.org-article:c803090fc57f49e9acae31fda9b40c0e2021-12-01T04:38:03ZPrognostic Factors for Surgical Failure in Malignant Bowel Obstruction and Peritoneal Carcinomatosis2296-875X10.3389/fsurg.2021.769658https://doaj.org/article/c803090fc57f49e9acae31fda9b40c0e2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fsurg.2021.769658/fullhttps://doaj.org/toc/2296-875XIntroduction: Patients with peritoneal metastasis frequently develop malignant bowel obstruction (MBO). Medical palliative management is preferred but often fails. Conversely, the role of palliative surgery remains unclear and debated. This study aims to identify patients who could benefit from invasive surgical interventions and factors associated with successful surgical palliation.Materials and Methods: In this retrospective study, 98 consecutive patients who underwent palliative surgery for MBO over 5 years were reviewed. We evaluate as the primary outcome surgical failure to select patients who could benefit from palliative surgery, avoiding unnecessary surgery. A prognostic score was developed based on a logistic regression model to identify patients at risk of surgical failure. The score was evaluated for overall accuracy by receiver operating characteristic curve analysis.Results: Palliative surgery was achieved in 76 (77.5%) patients. The variables that were found to be significant factors for surgical failure are recurrent disease (P = 0.015), absence of bowel obstruction (P < 0.001), absence of bowel distension (P < 0.001), and mesenteric involvement (P = 0.001) and retraction (P < 0.001). The absence of bowel distension (P = 0.046) and bowel obstruction (P = 0.012) emerged as independent predictors of surgical failure. Carcinomatosis level assessment for peritoneum score, based on these factors, was built to evaluate the risk of surgical failure.Conclusion: Our proposed scoring system might help select patients most likely to benefit from palliative surgery.Claudio LodoliMarcello CovinoMarcello CovinoMiriam Attalla El HalabiehMiriam Attalla El HalabiehFrancesco SantulloAndrea Di GiorgioAndrea Di GiorgioCarlo AbatiniCarlo AbatiniStefano RotoloElena RodolfinoElena RodolfinoFrancesco GiovinazzoAnna FagottiAnna FagottiGiovanni ScambiaGiovanni ScambiaFrancesco FranceschiFrancesco FranceschiFabio PacelliFabio PacelliFrontiers Media S.A.articlemalignant bowel obstruction (MBO)peritoneal carcinomatosis (PC)surgical palliationileostomypalliative outcomesSurgeryRD1-811ENFrontiers in Surgery, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	malignant bowel obstruction (MBO) peritoneal carcinomatosis (PC) surgical palliation ileostomy palliative outcomes Surgery RD1-811
spellingShingle	malignant bowel obstruction (MBO) peritoneal carcinomatosis (PC) surgical palliation ileostomy palliative outcomes Surgery RD1-811 Claudio Lodoli Marcello Covino Marcello Covino Miriam Attalla El Halabieh Miriam Attalla El Halabieh Francesco Santullo Andrea Di Giorgio Andrea Di Giorgio Carlo Abatini Carlo Abatini Stefano Rotolo Elena Rodolfino Elena Rodolfino Francesco Giovinazzo Anna Fagotti Anna Fagotti Giovanni Scambia Giovanni Scambia Francesco Franceschi Francesco Franceschi Fabio Pacelli Fabio Pacelli Prognostic Factors for Surgical Failure in Malignant Bowel Obstruction and Peritoneal Carcinomatosis
description	Introduction: Patients with peritoneal metastasis frequently develop malignant bowel obstruction (MBO). Medical palliative management is preferred but often fails. Conversely, the role of palliative surgery remains unclear and debated. This study aims to identify patients who could benefit from invasive surgical interventions and factors associated with successful surgical palliation.Materials and Methods: In this retrospective study, 98 consecutive patients who underwent palliative surgery for MBO over 5 years were reviewed. We evaluate as the primary outcome surgical failure to select patients who could benefit from palliative surgery, avoiding unnecessary surgery. A prognostic score was developed based on a logistic regression model to identify patients at risk of surgical failure. The score was evaluated for overall accuracy by receiver operating characteristic curve analysis.Results: Palliative surgery was achieved in 76 (77.5%) patients. The variables that were found to be significant factors for surgical failure are recurrent disease (P = 0.015), absence of bowel obstruction (P < 0.001), absence of bowel distension (P < 0.001), and mesenteric involvement (P = 0.001) and retraction (P < 0.001). The absence of bowel distension (P = 0.046) and bowel obstruction (P = 0.012) emerged as independent predictors of surgical failure. Carcinomatosis level assessment for peritoneum score, based on these factors, was built to evaluate the risk of surgical failure.Conclusion: Our proposed scoring system might help select patients most likely to benefit from palliative surgery.
format	article
author	Claudio Lodoli Marcello Covino Marcello Covino Miriam Attalla El Halabieh Miriam Attalla El Halabieh Francesco Santullo Andrea Di Giorgio Andrea Di Giorgio Carlo Abatini Carlo Abatini Stefano Rotolo Elena Rodolfino Elena Rodolfino Francesco Giovinazzo Anna Fagotti Anna Fagotti Giovanni Scambia Giovanni Scambia Francesco Franceschi Francesco Franceschi Fabio Pacelli Fabio Pacelli
author_facet	Claudio Lodoli Marcello Covino Marcello Covino Miriam Attalla El Halabieh Miriam Attalla El Halabieh Francesco Santullo Andrea Di Giorgio Andrea Di Giorgio Carlo Abatini Carlo Abatini Stefano Rotolo Elena Rodolfino Elena Rodolfino Francesco Giovinazzo Anna Fagotti Anna Fagotti Giovanni Scambia Giovanni Scambia Francesco Franceschi Francesco Franceschi Fabio Pacelli Fabio Pacelli
author_sort	Claudio Lodoli
title	Prognostic Factors for Surgical Failure in Malignant Bowel Obstruction and Peritoneal Carcinomatosis
title_short	Prognostic Factors for Surgical Failure in Malignant Bowel Obstruction and Peritoneal Carcinomatosis
title_full	Prognostic Factors for Surgical Failure in Malignant Bowel Obstruction and Peritoneal Carcinomatosis
title_fullStr	Prognostic Factors for Surgical Failure in Malignant Bowel Obstruction and Peritoneal Carcinomatosis
title_full_unstemmed	Prognostic Factors for Surgical Failure in Malignant Bowel Obstruction and Peritoneal Carcinomatosis
title_sort	prognostic factors for surgical failure in malignant bowel obstruction and peritoneal carcinomatosis
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/c803090fc57f49e9acae31fda9b40c0e
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Prognostic Factors for Surgical Failure in Malignant Bowel Obstruction and Peritoneal Carcinomatosis

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