Surgical Treatment for Malignant Small Bowel Obstruction Offers Best Patient-Reported Outcomes

Bateni SB, Law CHL, Nadler A, et al. Patient-Reported Symptom Burden Associated with Treatment Modality for Malignant Bowel Obstruction. Ann Surg. 2025.

Malignant bowel obstruction (MBO) is observed in nearly one-third of patients with gastrointestinal cancers. MBO patients suffer from debilitating pain, nausea, and loss of appetite, and patients and families experience uncertainty and emotional distress.

Treatments for MBO include nasogastric decompression, antiemetic and antisecretory medications, procedural interventions (venting gastrostomy, stenting), and surgical procedures such as ostomy creation, intestinal resection, and intestinal bypass. Choosing the proper approach is challenging due to the lack of data on outcomes of these components of palliative care.

The authors reviewed a prospective database of patients with MBO (n = 1,749) treated in Canadian centers. Standard symptom score scales were used to assess the outcomes of treatment. Symptoms such as fatigue, lack of well-being, and lack of appetite were the most common reported before and after diagnosis of MBO.

Surgical treatment was used in 55.3% of patients; medical care and procedural interventions were used in 38.5% and 6.2%, respectively. Symptom scores (except for lack of appetite and pain) improved in all treatment groups. Surgical treatment relieved lack of appetite and pain in a significantly higher proportion of patients compared with other treatments.

The authors concluded that patients who are deemed to be acceptable for surgical management of MBO should be offered this treatment.