Bowel obstruction and peritoneal carcinomatosis in the elderly. A systematic review

Background: There are not guidelines for surgical management of malignant bowel obstruction (MBO) caused by peritoneal carcinomatosis (PC), mainly when it involves elderly; so its treatment is still debated. Aim: To outline indications and benefits of palliative surgery for obstructive carcinomatosis and determine what prognostic factors, including age, have independent and significant association with outcome. Methods: We conducted English-language MEDLINE and EMBASE searches of articles published between 1998 and 2016, which reported outcome data after palliative surgery for MBO due to PC. We excluded all articles lacking of surgical cohort and those with main interest in conservative treatment. Of 1275 articles identified, 12 satisfied selection criteria and were included in our analysis. Results: Overall, these studies involved 548 patients undergoing palliative surgery for MBO caused by PC. The median age was 58 (range 19–93). Relief of symptoms was achieved in 26.5–100% of cases. Postoperative morbidity ranged between 7 and 44%. Mortality was high (6–22%). The median survival was longer in surgical patients than in those receiving conservative therapy (8–34 vs 4–5 weeks). Factors associated with surgery failure were poor performance status, diffuse carcinomatosis, previous radiotherapy, and obstruction of small bowel. Old age was significantly associated with a poor prognosis upon univariate analysis, while this association vanished upon multivariate analysis. Conclusions: Surgical palliation can provide relief of obstructive symptoms as well as improved survival in well-selected patients, even if elderly.