Palliative treatment of intestinal obstruction in patients with gynecologic malignancies - single center experience

Abstract

Objectives: One of the common symptoms in patients with advanced gynecologic tumors is intestinal obstruction. Palliative management may include pharmacological treatment, stenting as well as surgical removal of obstruction cause. Selection of appropriate treatment should be based on careful and individual assessment of advantages, disadvantages and possible complications. The aim of the study was to analyze the effectiveness of non-invasive treatment in patients with gynecologic malignancies suffering from intestinal obstruction. Material and methods: It was a retrospective analysis of factors associated with primary non-invasive intestinal obstruction treatment effectiveness. Data were collected from medical records of 17 patients managed and followed-up in a single gynecologic oncology center due to endometrial cancer, fallopian tube cancer, uterine leiomyosarcoma, and ovarian cancer admitted to the ward because of symptomatic intestinal obstruction. Mean observation time lasted 40.6 months. Non-invasive treatment included fluid therapy, dexamethasone, buscolysin, mebeverine, ranitidine, simethicone, omeprazole, magnesium sulphate, semi-liquid diet, and parenteral nutrition. Characteristics including age, BMI, comorbidities, oncological treatment, histology type, stage, grade, presence of ascites, location of primary tumor and metastases were analyzed. Results: The number of obstruction episodes varied from 1 to 5. Mean time between multiple episodes lasted 3.2 months. 5 patients required surgical treatment. For the rest of the patients primary non-invasive treatment was sufficient. Conclusions: Most cases of bowel obstruction in patients with advanced gynecologic malignancies can be successfully managed without invasive treatment. Moreover, non-invasive obstruction management can be applied multiple times in case of recurrence.