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Benefit of palliative surgery for bowel obstruction in advanced ovarian cancer.

OBJECTIVES
To determine the benefit of palliative surgery for patients with advanced ovarian cancer and bowel obstruction and to identify criteria for selecting patients who are most likely to benefit from palliation.


DESIGN
A retrospective study of patients treated between 1982 and 1992.


SETTING
A university-affiliated hospital.


PATIENTS
Fifty-three patients with complete and unresolved bowel obstruction caused by ovarian cancer.


INTERVENTION
Surgery for relief of bowel obstruction.


MAIN OUTCOME MEASURES
Postoperative survival longer than 60 days, return home and relief of bowel obstruction for longer than 60 days, factors associated with failure of palliative surgery.


RESULTS
Successful palliation was achieved in 27 (51%) patients and was associated with the absence of four prognostic factors: palpable abdominal and pelvic masses, ascites exceeding 3 L, multiple obstructive sites and preoperative weight loss greater than 9 kg. Age, time interval between diagnosis of ovarian cancer and bowel obstruction, stage of disease at initial diagnosis, tumour type and grade, site and degree of obstruction, presence of gross residual tumour after initial operation and preoperative use of chemotherapy or radiotherapy did not indicate the success or failure of palliative surgery.


CONCLUSIONS
Palliative surgery for bowel obstruction in advanced ovarian cancer can be worthwhile, and there are four prognostic factors that indicate the likely failure of palliation.