TY - JOUR
T1 - Intestinal perforation in gynecologic oncology
T2 - Do all patients benefit from surgical management?
AU - Garg, Gunjal
AU - Massad, L. Stewart
AU - Pourabolghasem, Shabnam
AU - Zhou, Gongfu
AU - Powell, Matthew A.
AU - Thaker, Premal H.
AU - Hagemann, Andrea R.
AU - Wilkinson-Ryan, Ivy
AU - Mutch, David G.
N1 - Funding Information:
We thank Deborah J. Frank for constructive criticism of the manuscript. “The Siteman Cancer Center is supported by NCI Cancer Center Support Grant P30 CA91842 ”. “The CTSA award grant UL1RR02499 2”.
PY - 2013/6
Y1 - 2013/6
N2 - Objective To identify those patients with gynecologic cancers and intestinal perforation in whom conservative management may be appropriate. Methods A retrospective review was performed of all gynecologic oncology patients with intestinal perforation at our institution between 1995 and 2011. The Kaplan-Meier method and Cox proportional hazards models were used to analyze factors influencing survival. Results Forty-three patients met the study criteria. The mean age was 59 years (range: 38-82 years). A large number of patients had peritoneal carcinomatosis and history of bowel obstruction. Surgery was performed in 28 patients, and 15 were managed conservatively. Overall mortality at 1, 3, 6, and 12 months was 26%, 40%, 47%, and 59%, respectively. Only cancer burden at the time of perforation was independently predictive of mortality. Patients with peritoneal carcinomatosis, distant metastasis, or both were at 42 times higher risk of death than those with no evidence of disease (95% CI: 3.28-639.83), and at 7 times higher risk of death than those with microscopic/localized disease (95% CI: 1.77-29.94). When adjusted for the extent of disease spread, management approach (conservative vs. surgical) was not a significant predictor of survival (p ≥ 0.05). The length of hospital stay (19 days vs. 7 days) and the complication rate (75% vs. 26.7%) were significantly higher in the surgical group than in the non-surgical group (p < 0.05). Conclusions Patients who develop intestinal perforation in the setting of widely metastatic disease have a particularly poor prognosis. Aggressive surgical management is unlikely to benefit such patients and further impairs their quality of life.
AB - Objective To identify those patients with gynecologic cancers and intestinal perforation in whom conservative management may be appropriate. Methods A retrospective review was performed of all gynecologic oncology patients with intestinal perforation at our institution between 1995 and 2011. The Kaplan-Meier method and Cox proportional hazards models were used to analyze factors influencing survival. Results Forty-three patients met the study criteria. The mean age was 59 years (range: 38-82 years). A large number of patients had peritoneal carcinomatosis and history of bowel obstruction. Surgery was performed in 28 patients, and 15 were managed conservatively. Overall mortality at 1, 3, 6, and 12 months was 26%, 40%, 47%, and 59%, respectively. Only cancer burden at the time of perforation was independently predictive of mortality. Patients with peritoneal carcinomatosis, distant metastasis, or both were at 42 times higher risk of death than those with no evidence of disease (95% CI: 3.28-639.83), and at 7 times higher risk of death than those with microscopic/localized disease (95% CI: 1.77-29.94). When adjusted for the extent of disease spread, management approach (conservative vs. surgical) was not a significant predictor of survival (p ≥ 0.05). The length of hospital stay (19 days vs. 7 days) and the complication rate (75% vs. 26.7%) were significantly higher in the surgical group than in the non-surgical group (p < 0.05). Conclusions Patients who develop intestinal perforation in the setting of widely metastatic disease have a particularly poor prognosis. Aggressive surgical management is unlikely to benefit such patients and further impairs their quality of life.
KW - Intestinal perforation
KW - Management
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=84877575143&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2013.03.004
DO - 10.1016/j.ygyno.2013.03.004
M3 - Article
C2 - 23500088
AN - SCOPUS:84877575143
SN - 0090-8258
VL - 129
SP - 538
EP - 543
JO - Gynecologic oncology
JF - Gynecologic oncology
IS - 3
ER -