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Bowel Obstruction in Ovarian Cancer: To Operate or Not?

  • Ram Eitan
  • Alexander de Graeff
  • Dennis S. Chi
Chapter

Abstract

Because of its unique pattern of spread, bowel obstruction is a common complication in patients with advanced ovarian carcinoma. Bowel obstruction may be partial or complete and frequently involves multiple segments, leading to proximal distention of the gastrointestinal tract and the associated symptoms of nausea, vomiting, and abdominal pain. The initial management should include restriction of oral intake, intravenous fluid repletion, antiemetics, and pain control, as needed, together with gastrointestinal decompression through a nasogastric tube if vomiting is copious and/or persistent. Surgical intervention is contemplated when the initial phase of conservative supportive treatment fails. It is usually challenging and implies either adhesiolysis or the creation of an ileostomy or colostomy. The role of surgery in malignant bowel obstruction due to advanced ovarian cancer remains controversial. Nonsurgical management includes palliative chemotherapy, stent placement for local obstruction, and palliation of symptoms, in particular vomiting and pain. The main consideration for the choice of treatment should be its effect on quality of life. The key issue, therefore, is optimal selection of those who are likely to improve after surgery and to refrain from surgery in patients who are unlikely to benefit. There is an urgent need for randomized trials to assess the best treatment for malignant bowel obstruction. Ideally, these should be randomized controlled trials, comparing different approaches, using symptom control and quality of life as primary endpoints.

Keywords

Ovarian Cancer Bowel Obstruction Bowel Wall Total Parenteral Nutrition Ovarian Cancer Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Ram Eitan
    • 1
  • Alexander de Graeff
    • 2
  • Dennis S. Chi
    • 3
  1. 1.Gynecologic Oncology Division, Department of Obstetrics and GynecologyRabin Medical Center, Sackler School of Medicine, Tel Aviv UniversityPetah TikvaIsrael
  2. 2.Medical OncologyUniversity Medical Center UtrechtUtrechtThe Netherlands
  3. 3.Gynecology Service, Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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