Impact of short-term efficacy after conservative treatment of bowel obstruction on long-term survival of patients with malignant tumors of the digestive system.

[OBJECTIVE] To investigate the effect of short-term bowel obstruction outcomes on the long-term survival of patients with digestive system malignancies and bowel obstruction after conservative management.

[METHODS] Clinical information, treatment methods, and outcomes of 110 patients with digestive system malignant tumors (gastric cancer, colorectal cancer, and hepatobiliary pancreatic cancer) complicated with bowel obstruction were collected retrospectively. Survival of the patients was determined to observe the impact of short-term outcomes following bowel obstruction treated conservatively, on long-term survival.

[RESULTS] The median age of the 110 patients with digestive system malignancies complicated by bowel obstruction was 60 years (range: 31-86 years). The median time from diagnosis of digestive malignancy to the development of bowel obstruction was 5.5 months (range: 1.0-22.2 months). The rate of ileus relief with conservative management was 76.4% (84/110), and the median treatment duration was 4 days (range: 2-8 days). Hemoglobin, lymphocyte count, and albumin levels were lower, but the C-reactive protein (CRP) level was higher in patients with unrelieved bowel obstruction after conservative management (P < 0.05). Staging (odds ratio [OR] = 7.847, P = 0.03), previous chemotherapy (OR = 0.127, P = 0.002), previous radiotherapy (OR = 23.076, P = 0.003), and CRP level (OR = 17.788, P = 0.042) were independent risk factors for failure of remission from obstruction by conservative management. The median follow-up period was 35 months, and the median survival time was 40.0 months. The median survival time of patients with relief from bowel obstruction managed conservatively was longer than that of those without relief of obstruction (49 vs. 16 months, P = 0.023). Multivariate analysis suggested that stage III-IV and previous tumor surgery were independent factors for survival in patients of digestive system malignancies with bowel obstruction (hazard ratio [HR] = 2.847, 95% CI 1.024-7.912, P = 0.045; HR = 0.377, 95% CI 0.199-0.716, P = 0.003, respectively).

[CONCLUSION] Short-term outcome of pharmacological conservative treatment after bowel obstruction in malignant tumors of the digestive system influences patients' long-term survival but is not an independent prognostic factor. Staging and previous tumor surgery are independent prognostic factors influencing survival in patients with malignancies of the digestive system combined with bowel obstruction.