Natural History and Management of Small-Bowel Obstruction in Patients After Cytoreductive Surgery and Intraperitoneal Chemotherapy

Eyal Mor, Shanie Shemla, Dan Assaf, Shachar Laks, Haggai Benvenisti, David Hazzan, Mai Shiber, Einat Shacham-Shmueli, Ofer Margalit, Naama Halpern, Ben Boursi, Tamar Beller, Daria Perelson, Ofer Purim, Douglas Zippel, Almog Ben-Yaacov, Aviram Nissan, Mohammad Adileh*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Small-bowel obstruction (SBO) after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a common complication associated with re-admission that may alter patients’ outcomes. Our aim was to characterize and investigate the impact of bowel obstruction on patients’ prognosis. Methods: This was a retrospective analysis of patients with SBO after CRS/HIPEC (n = 392). We analyzed patients’ demographics, operative and perioperative details, SBO re-admission data, and long-term oncological outcomes. Results: Out of 366 patients, 73 (19.9%) were re-admitted with SBO. The cause was adhesive in 42 (57.5%) and malignant (MBO) in 31 (42.5%). The median time to obstruction was 7.7 months (range, 0.5–60.9). Surgical intervention was required in 21/73 (28.7%) patients. Obstruction eventually resolved (spontaneous or by surgical intervention) in 56/73 (76.7%) patients. Univariant analysis identified intraperitoneal chemotherapy agents: mitomycin C (MMC) (HR 3.2, p = 0.003), cisplatin (HR 0.3, p = 0.03), and doxorubicin (HR 0.25, p = 0.018) to be associated with obstruction-free survival (OFS). Postoperative complications such as surgical site infection (SSI), (HR 2.2, p = 0.001) and collection (HR 2.07, p = 0.015) were associated with worse OFS. Multivariate analysis maintained MMC (HR 2.9, p = 0.006), SSI (HR 1.19, p = 0.001), and intra-abdominal collection (HR 2.19, p = 0.009) as independently associated with OFS. While disease-free survival was similar between the groups, overall survival (OS) was better in the non-obstruction group compared with the obstruction group (p = 0.03). Conclusions: SBO after CRS/HIPEC is common and complex in management. Although conservative management was successful in most patients, surgery was required more frequently in patients with MBO. Patients with SBO demonstrate decreased survival.

Original languageEnglish
Pages (from-to)8566-8579
Number of pages14
JournalAnnals of Surgical Oncology
Issue number13
StatePublished - Dec 2022


Dive into the research topics of 'Natural History and Management of Small-Bowel Obstruction in Patients After Cytoreductive Surgery and Intraperitoneal Chemotherapy'. Together they form a unique fingerprint.

Cite this