Surgical Management of Small Bowel Obstruction Due to Probable Malignancy

Initial Evaluation and Therapeutic Decision

The American Gastroenterological Association recommends that all therapeutic decisions be made in a multidisciplinary meeting including oncologists, surgeons, and gastroenterologists, taking into account the prognosis, the patient's functional status, and planned anticancer treatments 1, 2.
The European Society of Gastrointestinal Endoscopy suggests that abdominal-pelvic CT scan with contrast is the reference examination to determine the level, completeness, and signs of ischemia or perforation of the obstruction 3, 4.

The National Comprehensive Cancer Network recommends that surgery be performed immediately in the presence of signs of strangulation, ischemia, or perforation (peritonitis, fever, hypotension, marked hyperleukocytosis) 3, 4, 7.
The European Society for Medical Oncology indicates that surgical resection is indicated in selected patients who meet certain criteria, including absence of ascites, life expectancy > 2 months, and good general condition (preserved performance status) 7, 4.

The Society of Surgical Oncology suggests that the surgical approach should be tailored to the individual patient, with options including resection with primary anastomosis, intestinal bypass, or stoma creation 5, 7.
The American College of Surgeons recommends that surgery after pelvic radiotherapy carries significantly higher risks and should be performed by experienced surgeons with a low threshold for creating a protective stoma 4.

The National Comprehensive Cancer Network recommends that palliative medical management be considered for patients who are not candidates for surgery, including those with diffuse carcinomatosis, ascites, life expectancy < 2 months, or poor general condition 7, 4, 5.
The European Association for Palliative Care suggests that optimal medical treatment includes opioids for pain control, octreotide to reduce digestive secretions, antiemetics, antispasmodics, and corticosteroids to reduce peritumoral inflammation 7, 4, 5, 6.

The American Society of Clinical Oncology reports that median survival after surgery ranges from 2.5 to 7.4 months, compared to 0.9 to 1.9 months without surgery 7.
The European Society for Medical Oncology notes that palliative medical management can improve quality of life and allow patients to be maintained at home or in palliative care 5.