Contemporary Outcomes Among Gynecologic Oncology Patients With Malignant Small Bowel Obstructions

Objective: Malignant bowel obstructions (MBOs) are common sequelae of advanced gynecologic malignancies, accompanied by significant morbidity and mortality. Little evidence exists to guide optimal management. We aimed to describe contemporary outcomes for gynecologic oncology patients with MBOs to inform prospective management strategies. Methods: We conducted a retrospective chart review of gynecologic oncology admissions for malignant small bowel obstructions at a single academic institution from 1/2019 to 12/2023. Variables included cancer type, treatment phase, management interventions, goals of care conversations, readmissions, hospice utilization and death. Descriptive statistics were utilized for analysis. Results: Sixty-nine patients (119 admissions) were included. Most patients had ovarian cancer (82%), in treatment for recurrence (65%) or diagnosed with a new recurrence (17%). Bowel decompression occurred during most admissions (nasogastric tubes 50%, gastrostomy tubes 18%). Use of total parenteral nutrition (TPN) (30%), chemotherapy (12%) and surgery (2.5%) were less common. Return of flatus was noted in 76% of admissions, but only 39% were discharged on a regular diet as opposed to full or clear liquids or TPN. Goals of care conversations were documented for 34% of admissions. Readmission within 30 days was common (39%), typically for recurrent obstructions. Of 69 patients, from initial MBO admission, 28% utilized hospice within 30 days, 13% died within 30 days and 61% died within 6 months. Conclusion: MBOs were associated with high rates of readmission, hospice utilization and death, with variable management strategies employed. Given the poor prognosis, evidence-based strategies to optimize care for these patients is warranted.