Outcomes of palliative surgery for bowel obstruction in end of life ovarian cancer care in a tertiary cancer centre

Abstract

Objective: We studied the demographic of patients with ovarian cancer in end of life care undergoing palliative surgery for bowel obstruction in relation to its success in restoring bowel function and enhancing other aspects of palliative care, including discharge from the acute hospital setting. Methods: Hospital data on all consecutive ovarian cancer patients who underwent palliative surgery for bowel obstruction over five years up to end December 2017 was analysed. Successful palliation was measured by relief of bowel obstruction and discharge from the acute hospital setting. Results: Twenty-eight patients were identified. The mean age at time of surgery was 64.75 years. Histology was high grade serous in the majority (63.5%). Substantial co-morbidites were cardiovascular (10.7%) and respiratory (14.3%) at initial diagnosis. Surgery was performed on average after 13 days of conservative management of bowel obstruction (Standard deviation (SD) 10.6 days). All had some procedure for bowel decompression; 82% (23) required stoma including gastrostomy 10% (3); jejunostomy 3% (1); ileostomy loop 25% (7), double barrel ileostomy 3% (1), end ileostomy 10% (3); colostomy loop 10% (3), end colostomy 14% (4); end ileostomy & loop colostomy 3% (1). No stoma was required in 18% (5). 42.8% (12) had an anastomosis to bypass obstruction and five of these did not require a stoma. Postoperative complications arose in 30%. Sixteen had protracted hospital stay after surgery, 14 for clinical reasons and 2 for social/domestic reasons. Two patients died in the acute hospital following surgery. Median survival following surgery was 84 days. Conclusions: The management of bowel obstruction in end of life care in ovarian cancer is a common and challenging clinical task. Surgery to palliate bowel obstruction was successful in the majority of this cohort of patients with advanced ovarian cancer in end of life care.