Surgery, No Surgery Compared for Malignant Small Bowel Obstruction

WEDNESDAY, Aug. 9, 2023 (HealthDay News) -- For patients with malignant small bowel obstruction, surgical versus nonsurgical management does not influence the number of days alive and out of the hospital at 91 days, according to a study published online Aug. 1 in The Lancet Gastroenterology & Hepatology.

Robert S. Krouse, M.D., from the University of Pennsylvania in Philadelphia, and colleagues conducted a pragmatic comparative effectiveness trial within the National Cancer Trials Network. Participants were adults with an intra-abdominal or retroperitoneal primary cancer confirmed via pathological report and malignant bowel disease and were randomly assigned to surgical or nonsurgical treatment; patients who declined consent for randomization were offered an observational patient choice pathway. Data were included for 199 evaluable patients: 49 in the randomized pathway (24 to surgery and 25 to no surgery) and 150 in the patient choice pathway (58 surgery and 92 no surgery). The number of days alive and out of the hospital (good days) at 91 days was assessed as the primary outcome.

The researchers found that for the primary outcome, there was no difference between the surgery and nonsurgery groups (mean, 42.6 and 43.9 good days in the randomized groups, respectively; 54.8 and 52.7 good days in the patient choice surgery and nonsurgery groups, respectively [adjusted mean difference, 2.9 additional good days in the surgery versus nonsurgery group; 95 percent confidence interval, −5.5 to 11.3; P = 0.50). Anemia was the most common grade 3 to 4 treatment complication (three patients in the randomized pathway, all in the surgical group; five patients in the patient choice pathway, four in the surgical group and one in the nonsurgical group) .

"The study did not show a significant effect on survival by day 91, but the hazard ratio was consistent with a possible benefit for surgery when compared with nonoperative approaches; longer-term follow-up might clarify this association," the authors write.

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