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; Thomas M. Drake; Matthew J. Lee; Adele E. Sayers; John Abercrombie; Austin Acheson; Derek Alderson; Iain Anderson; Mike Bradburn; R. Moynihan

doi: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, Thomas M. Drake^*, Matthew J. Lee, Adele E. Sayers, John Abercrombie, Austin Acheson, Derek Alderson, Iain Anderson, Mike Bradburn, R. Moynihan

^*Corresponding author for this work

Institute for Evidence-Based Healthcare

Research output: Contribution to journal › Article › Research › peer-review

11 Citations (Scopus)

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 language	English
Pages (from-to)	2319-2324
Number of pages	6
Journal	European Journal of Surgical Oncology
Volume	45
Issue number	12
DOIs	https://doi.org/10.1016/j.ejso.2019.07.014
Publication status	Published - Dec 2019

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10.1016/j.ejso.2019.07.014

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National Audit of Small Bowel Obstruction Steering Group & National Audit of Small Bowel Obstruction Collaborators, Drake, T. M., Lee, M. J., Sayers, A. E., Abercrombie, J., Acheson, A., Alderson, D., Anderson, I., Bradburn, M., & Moynihan, R. (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

@article{c0ef4ed2b8bf49c6a9af6bc162fb3b2a,

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 and D. Cotton and P. Coyne and J. Crozier and T. Cook and P. Cunha and N. Curtis and A. Day and S. Dayal and R. Dennis and P. Dent and H. Dowson and R. Fallaize and S. Farag and {El Farran}, M. and G. Faulkner and P. Giordano and T. Grey and V. Halahakoon and J. Hannay and A. Harikrishnan and S. Holtham and P. Hawkin and C. Hall and L. Hancock and J. Hartley and F. Howse and R. Kallam and G. Kakaniaris and S. Kelly and S. Lockwood and D. Leinhardt and B. Levy and R. Lal and T. Lazim and J. Lund and R. Lunevicius and P. Mathur and K. Maude and D. McArthur and B. McIlroy and A. Miles and S. Moug and M. Mondragon-Pritchard and D. Messenger and M. Mullan and A. Myers and K. Muhammad and C. Mason and J. Sarveswaran and V. Shatkar and B. Singh and B. Skelly and S. Subramonia and M. Swinscoe and B. Thava and C. Thorn and S. Panagiotopoulos and P. Patel and J. Phillips and I. Peristerakis and A. Qureshi and M. Saunders and P. Shah and A. Sheel and S. Siddiqui and P. Skaife and N. Smart and I. Smith and L. Stevenson and N. Stylianides and J. Steinke and B. Stubbs and R. Thompson and M. Varcada and D. Vimalachandran and I. Virlos and J. Watfah and N. Watson and M. Walker and N. Ventham and H. West and J. Wilson and S. Wijeyekoon and J. Ah-Chuen and T. Ahmed and F. Akram and E. Aldred and A. Ali and M. Aly and A. Amajuoyi and V. Amin and A. Andreou and A. Ansari and R. Ardley and F. Arshad and O. Ashour and A. Asour and F. Ayoub and H. Azeem and B. Azhar and C. Baillie and J. Barker and B. Barkham and R. Baron and J. Barrie and E. Barry-Yarrow and N. Battersby and G. Bazoua and C. Berger and S. Bhasin and S. Biggs and C. Bisset and N. Blencowe and A. Boddy and C. Boereboom and M. Bogdan and R. Bogle and P. Bohra and H. Bolkan and M. Boyer and J. Broadhurst and E. Brown and J. Brown and K. Burns and K. Butcher and C. Capper and T. Cash and J. Chapman and S. Chapman and A. Charalabopoulos and C. Cheek and S. Chok and W. Choong and J. Chowdhury and P. Coe and G. Conn and R. Crook and G. Cuffolo and {da Silva}, L. and B. Das and M. Davenport and R. Moynihan",

note = "Publisher Copyright: {\textcopyright} 2019 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology",

year = "2019",

month = dec,

doi = "10.1016/j.ejso.2019.07.014",

language = "English",

volume = "45",

pages = "2319--2324",

journal = "European Journal of Surgical Oncology",

issn = "0748-7983",

publisher = "W.B. Saunders Ltd",

number = "12",

}

National Audit of Small Bowel Obstruction Steering Group & National Audit of Small Bowel Obstruction Collaborators, Drake, TM, Lee, MJ, Sayers, AE, Abercrombie, J, Acheson, A, Alderson, D, Anderson, I, Bradburn, M & Moynihan, R 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; Drake, Thomas M.; Lee, Matthew J. et al.
In: European Journal of Surgical Oncology, Vol. 45, No. 12, 12.2019, p. 2319-2324.

Research output: Contribution to journal › Article › Research › peer-review

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.

AU - Cotton, D.

AU - Coyne, P.

AU - Crozier, J.

AU - Cook, T.

AU - Cunha, P.

AU - Curtis, N.

AU - Day, A.

AU - Dayal, S.

AU - Dennis, R.

AU - Dent, P.

AU - Dowson, H.

AU - Fallaize, R.

AU - Farag, S.

AU - El Farran, M.

AU - Faulkner, G.

AU - Giordano, P.

AU - Grey, T.

AU - Halahakoon, V.

AU - Hannay, J.

AU - Harikrishnan, A.

AU - Holtham, S.

AU - Hawkin, P.

AU - Hall, C.

AU - Hancock, L.

AU - Hartley, J.

AU - Howse, F.

AU - Kallam, R.

AU - Kakaniaris, G.

AU - Kelly, S.

AU - Lockwood, S.

AU - Leinhardt, D.

AU - Levy, B.

AU - Lal, R.

AU - Lazim, T.

AU - Lund, J.

AU - Lunevicius, R.

AU - Mathur, P.

AU - Maude, K.

AU - McArthur, D.

AU - McIlroy, B.

AU - Miles, A.

AU - Moug, S.

AU - Mondragon-Pritchard, M.

AU - Messenger, D.

AU - Mullan, M.

AU - Myers, A.

AU - Muhammad, K.

AU - Mason, C.

AU - Sarveswaran, J.

AU - Shatkar, V.

AU - Singh, B.

AU - Skelly, B.

AU - Subramonia, S.

AU - Swinscoe, M.

AU - Thava, B.

AU - Thorn, C.

AU - Panagiotopoulos, S.

AU - Patel, P.

AU - Phillips, J.

AU - Peristerakis, I.

AU - Qureshi, A.

AU - Saunders, M.

AU - Shah, P.

AU - Sheel, A.

AU - Siddiqui, S.

AU - Skaife, P.

AU - Smart, N.

AU - Smith, I.

AU - Stevenson, L.

AU - Stylianides, N.

AU - Steinke, J.

AU - Stubbs, B.

AU - Thompson, R.

AU - Varcada, M.

AU - Vimalachandran, D.

AU - Virlos, I.

AU - Watfah, J.

AU - Watson, N.

AU - Walker, M.

AU - Ventham, N.

AU - West, H.

AU - Wilson, J.

AU - Wijeyekoon, S.

AU - Ah-Chuen, J.

AU - Ahmed, T.

AU - Akram, F.

AU - Aldred, E.

AU - Ali, A.

AU - Aly, M.

AU - Amajuoyi, A.

AU - Amin, V.

AU - Andreou, A.

AU - Ansari, A.

AU - Ardley, R.

AU - Arshad, F.

AU - Ashour, O.

AU - Asour, A.

AU - Ayoub, F.

AU - Azeem, H.

AU - Azhar, B.

AU - Baillie, C.

AU - Barker, J.

AU - Barkham, B.

AU - Baron, R.

AU - Barrie, J.

AU - Barry-Yarrow, E.

AU - Battersby, N.

AU - Bazoua, G.

AU - Berger, C.

AU - Bhasin, S.

AU - Biggs, S.

AU - Bisset, C.

AU - Blencowe, N.

AU - Boddy, A.

AU - Boereboom, C.

AU - Bogdan, M.

AU - Bogle, R.

AU - Bohra, P.

AU - Bolkan, H.

AU - Boyer, M.

AU - Broadhurst, J.

AU - Brown, E.

AU - Brown, J.

AU - Burns, K.

AU - Butcher, K.

AU - Capper, C.

AU - Cash, T.

AU - Chapman, J.

AU - Chapman, S.

AU - Charalabopoulos, A.

AU - Cheek, C.

AU - Chok, S.

AU - Choong, W.

AU - Chowdhury, J.

AU - Coe, P.

AU - Conn, G.

AU - Crook, R.

AU - Cuffolo, G.

AU - da Silva, L.

AU - Das, B.

AU - Davenport, M.

AU - Moynihan, R.

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.

UR - http://www.scopus.com/inward/record.url?scp=85075488699&partnerID=8YFLogxK

U2 - 10.1016/j.ejso.2019.07.014

DO - 10.1016/j.ejso.2019.07.014

M3 - Article

C2 - 31378418

AN - SCOPUS:85075488699

SN - 0748-7983

VL - 45

SP - 2319

EP - 2324

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

IS - 12

ER -

National Audit of Small Bowel Obstruction Steering Group & National Audit of Small Bowel Obstruction Collaborators, Drake TM, Lee MJ, Sayers AE, Abercrombie J, Acheson A et al. 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. doi: 10.1016/j.ejso.2019.07.014

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

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