Bowel Obstruction in Advanced or Recurrent Ovarian Cancer

Ming-Shyen, Yen  M.D.
Chief, Division of Gynecology
Department of Obstetrics and Gynecology
Taipei Veterans General Hospital
National Yang-Ming University

   Intestinal obstruction is a common sequela in patients with epithelial ovarian cancer, but it is a severe complication affecting survival and, moreover, quality of life.  Although the exact incidence of malignant bowel obstruction is unknown, several retrospective studies have estimated that it occurs in 25 to 50% of patients with ovarian cancer.
    The etiology of intestinal obstruction is progressive intra-abdominal tumor growth that leads to extrinsic occlusion of the bowel lumen and/or intraluminal occlusion due to pelvic recurrences or mesenteric or omental masses and intestinal motility disorders due to the infiltration of the mesentery or bowel muscle and nerves.  The goal of treatment becomes improving the quality of life in a patient with a limited life expectancy.  The treatment of bowel obstruction, surgical or medical, is not decided based on a fixed protocol, but the choice of therapy is individualized. 
Conservative treatment usually included nasogastric suction, percutaneous endoscopic gastrostomy, stents, intravenous fluid hydration, and drug administration, mainly using hyoscine butylbromide, haloperidol, corticosterioids, somatostain, and morphine; parenteral nutrition was administered in the perioperative period. 
The decision of whether to attempt surgical palliation is extremely difficult, and this operation is performed by a team composed of a gynecologic oncologist and a general surgeon.  When such a decision is under consideration, one must take into account the chance of successful palliation, risk of repeat obstruction, quality of life for the patient after the surgery, ability to administer future chemotherapy, as well as the rates of operative morbidity and mortality.
According the literature, if the surgery resulted in successful palliation, median survival was longer than all other patients with malignant bowel obstruction.  Selection of those patients who will benefit from this palliative surgery is not easy, and a big challenge for our gynecologic oncologists.

晚期及復發性卵巢癌導致的腸阻塞

陽明大學 醫學院 婦產科系
台北榮民總醫院 婦產部 婦科主任
顏明賢醫師

　　腸阻塞是上皮性卵巢癌常見的後遺症，確實是會影響存活的時間，甚至生活品質的嚴重併發症。雖然惡性腸阻塞確實的發生率不知。從幾篇回顧性的研究，估計在卵巢癌病患中約25到50%。
 腸阻塞的原因是逐漸從腹腔內的腫瘤，如：骨盆腔復發病灶或腸系膜或網膜腫瘤逐漸長大，導致腸腔外來的壓迫或腸腔內的阻塞，以及腸系網癌細胞侵潤腸肌肉及神經導致腸蠕動變差。治療的目標是針對有限生命時光的病患來改善其生活品質。腸阻塞的治療，不管內科或外科療法，不能依靠固定的方案，而是要依個人情況來選擇治療的方法。
 保守性治療通常包括鼻胃管抽吸，經皮下內視鏡胃造口，置放腸支架，靜脈點滴以及藥物的使用，主要包括抗膽鹼激性劑、抗精神病藥、類固醇、抑制胃泌素劑，嗎啡等。靜脈營養注射適應於手術前後時期。
 決定是否實施保守性手術是非常困難的，這類手術需要婦癌醫師及一般外科醫師的配合和合作。當要決定手術時，我們必需考慮到手術成功的機會、是否再次腸阻塞的危險、術後生活品質、是否可以進一步再接受化學治療，以及手術本身引起的併發症和死亡的機率。
 根據文獻的報告，腸阻塞的病人假如可以完成保守性的手術，其存活中間期會比其他處置方法活得長，針對卵巢癌導致腸阻塞的病患，選擇可以實施保守性手術的病患並不是那麼容易，這是婦癌醫師最大的挑戰。