Considerations in the Management Procedures of Malignant Large Bowel Obstruction; Surgical versus Conservative Management: Outcome and Prognostic Factors

Abstract

Abstract Introduction Malignant obstruction of the large bowel is a common clinical presentation, particularly in terminal cancer patients. Urgent resection and surgical diversion were the treatments of choice. Objective The aim of the current study was to compare urgent resection of the colon and surgical diversion as conservative management in patients presented with malignant colorectal obstruction regarding short-term, post-operative, prognostic, and long-term oncologic outcomes. Methods 80 patients with clinical and/or radiological evidence of malignant bowel obstruction distal to the ligament of Treitz and patients presented with incurable primary intra-abdominal primary cancer and patients with intra-peritoneal disease were included in the study. Patients were divided into 2 groups. The first group included 20 patients (25%) who underwent conservative management, while 60 patients (75%) underwent definitive surgical management. Results We showed statistically significant findings between both groups regarding the total length of hospital stay, the total amount of costs, the rate, and the interval of re-admission. The duration of staying at hospital and rate of re-admission in the group that was managed by definitive surgery is more than the group of patients that was managed by conservation. We found that the rate of postoperative complications and morbidity in patients who underwent urgent definitive surgical resection was higher than that in those who underwent conservative management. Conclusion In patients with malignant obstruction of the colon selection of definitive surgical management might not improve patients' outcomes and conservative management in addition to chemotherapy might be superior and might improve patients' outcomes and survival.