Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction

National Audit of Small Bowel Obstruction Steering Group & National Audit of Small Bowel Obstruction Collaborators

Research output: Contribution to journalArticle

Abstract

Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)2319-2324
Number of pages6
JournalEuropean Journal of Surgical Oncology
Volume45
Issue number12
DOIs
StatePublished - Dec 2019

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Neoplasms
Colonic Neoplasms
Hospital Mortality
Morbidity
Malnutrition
Mortality
Confidence Intervals
Gastrointestinal Stromal Tumors
Patient Rights
Proportional Hazards Models
Multicenter Studies
Intestines
Gastrointestinal Tract
Emergencies
Cohort Studies
Research

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

Cite this

National Audit of Small Bowel Obstruction Steering Group & National Audit of Small Bowel Obstruction Collaborators (2019). Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction. European Journal of Surgical Oncology, 45(12), 2319-2324. https://doi.org/10.1016/j.ejso.2019.07.014
National Audit of Small Bowel Obstruction Steering Group & National Audit of Small Bowel Obstruction Collaborators. / Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction. In: European Journal of Surgical Oncology. 2019 ; Vol. 45, No. 12. pp. 2319-2324.
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title = "Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction",
abstract = "Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.",
author = "{National Audit of Small Bowel Obstruction Steering Group & National Audit of Small Bowel Obstruction Collaborators} and Drake, {Thomas M.} and Lee, {Matthew J.} and Sayers, {Adele E.} and John Abercrombie and Austin Acheson and Derek Alderson and Iain Anderson and Mike Bradburn and Michael Davies and Zaed Hamady and Daniel Hind and Marianne Hollyman and Sarah Hare and Ellen Lee and John Northover and Christopher Lewis and Marriott, {Paul J.} and Nick Maynard and Malcolm McFall and Aravinth Muragananthan and David Murray and Pritam Singh and Gillian Tierney and Azmina Verjee and Ciaran Walsh and Wild, {Jonathan RL} and Timothy Wilson and S. Abbott and Y. Abdulaal and S. Afshar and M. Akhtar and D. Anderson and S. Appleton and D. Bandyopadhyay and G. Bashir and N. Behar and S. Bhandari and G. Branagan and R. Boulton and C. Borg and G. Bouras and J. Boyle and H. Brewer and L. Brown and C. Briggs and M. Cartmell and S. Chan and N. Chandratreya and P. Conaghan and J. Cornish",
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National Audit of Small Bowel Obstruction Steering Group & National Audit of Small Bowel Obstruction Collaborators 2019, 'Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction', European Journal of Surgical Oncology, vol. 45, no. 12, pp. 2319-2324. https://doi.org/10.1016/j.ejso.2019.07.014

Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction. / National Audit of Small Bowel Obstruction Steering Group & National Audit of Small Bowel Obstruction Collaborators.

In: European Journal of Surgical Oncology, Vol. 45, No. 12, 12.2019, p. 2319-2324.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction

AU - National Audit of Small Bowel Obstruction Steering Group & National Audit of Small Bowel Obstruction Collaborators

AU - Drake, Thomas M.

AU - Lee, Matthew J.

AU - Sayers, Adele E.

AU - Abercrombie, John

AU - Acheson, Austin

AU - Alderson, Derek

AU - Anderson, Iain

AU - Bradburn, Mike

AU - Davies, Michael

AU - Hamady, Zaed

AU - Hind, Daniel

AU - Hollyman, Marianne

AU - Hare, Sarah

AU - Lee, Ellen

AU - Northover, John

AU - Lewis, Christopher

AU - Marriott, Paul J.

AU - Maynard, Nick

AU - McFall, Malcolm

AU - Muragananthan, Aravinth

AU - Murray, David

AU - Singh, Pritam

AU - Tierney, Gillian

AU - Verjee, Azmina

AU - Walsh, Ciaran

AU - Wild, Jonathan RL

AU - Wilson, Timothy

AU - Abbott, S.

AU - Abdulaal, Y.

AU - Afshar, S.

AU - Akhtar, M.

AU - Anderson, D.

AU - Appleton, S.

AU - Bandyopadhyay, D.

AU - Bashir, G.

AU - Behar, N.

AU - Bhandari, S.

AU - Branagan, G.

AU - Boulton, R.

AU - Borg, C.

AU - Bouras, G.

AU - Boyle, J.

AU - Brewer, H.

AU - Brown, L.

AU - Briggs, C.

AU - Cartmell, M.

AU - Chan, S.

AU - Chandratreya, N.

AU - Conaghan, P.

AU - Cornish, J.

PY - 2019/12

Y1 - 2019/12

N2 - Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.

AB - Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.

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U2 - 10.1016/j.ejso.2019.07.014

DO - 10.1016/j.ejso.2019.07.014

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JF - European Journal of Surgical Oncology

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National Audit of Small Bowel Obstruction Steering Group & National Audit of Small Bowel Obstruction Collaborators. Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction. European Journal of Surgical Oncology. 2019 Dec;45(12):2319-2324. https://doi.org/10.1016/j.ejso.2019.07.014