Surgery for malignant small bowel obstruction did not reduce 90-day mortality

A comparison in which some patients with malignant small bowel obstruction were randomized and some chose between surgery and nonsurgical management found no difference in mortality between treatments, but surgery was associated with more symptom improvement.

An international pragmatic comparative effectiveness trial assessed outcomes in patients with an intra-abdominal or retroperitoneal primary cancer confirmed via pathological report, malignant bowel, a surgical indication, and treatment equipoise. Some were randomized to surgical or nonsurgical treatment; others who declined consent for randomization participated in a prospective observational patient choice arm of the study. Results, published by The Lancet Gastroenterology & Hepatology on Aug. 1, found no difference on the primary outcome of days alive and out of the hospital at 91 days by whether patients underwent. Surgery was associated with more inpatient complications such as anemia, but more improvement in symptoms at four weeks.

A more detailed summary of the study was published in the Aug. 9 ACP Hospitalist (ACP membership and ACP single sign-on required to read).