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Factors impacting length of stay and survival in patients with advanced gynecologic malignancies and malignant bowel obstruction
  1. Melissa Tigert1,
  2. Christine Lau2,3,
  3. Helen Mackay3,4,
  4. Stephanie L'Heureux3,5 and
  5. Lilian T. Gien3,6
  1. 1Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2Palliative Care, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  3. 3University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
  4. 4Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  5. 5Division of Medical Oncology, Princess Margaret Hospital Department of Medical Oncology and Hematology, Toronto, Ontario, Canada
  6. 6Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  1. Correspondence to Dr Lilian T. Gien, Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; Lilian.Gien{at}


Objectives Malignant bowel obstruction in patients with gynecologic malignancies can impose a large symptomatic burden. The objectives of this study were to identify factors associated with shorter length of hospital stay and overall survival in gynecologic oncology patients with malignant bowel obstructions.

Methods A retrospective chart review was performed from December 2014 to March 2019 on patients admitted to a tertiary care center with a malignant bowel obstruction and advanced gynecologic malignancy. Data collection included patient and tumor characteristics, malignant bowel obstruction management (such as conservative management with bowel rest, nasogastric tube, pharmacotherapy or active intervention with surgery, chemotherapy, radiation, total parenteral nutrition or interventional stents), length of hospital stay, and survival outcomes. Statistical analysis included comparisons with Student’s t-test and χ2 test, multivariable analysis, and survival analysis.

Results A total of 107 patients with gynecologic cancer with malignant bowel obstruction were included. The majority of patients (63%, n=67) had ovarian cancer. The median length of hospital stay was 12 days (range 1–23), with a median overall survival after malignant bowel obstruction diagnosis of 7 months (range 0.1–64.1). Patients with active interventions had a longer length of stay compared with those with conservative management (13 vs 6 days, p<0.001). However, patients who received multiple active interventions had increased overall survival (9.1 vs 2.9 months, p=0.049).

Conclusion Patients who received multimodal treatment for malignant bowel obstruction had an increased length of stay and improvement in survival of over 6 months. This emphasizes the importance of a multidisciplinary approach to actively manage malignant bowel obstruction in advanced gynecologic cancer.

  • palliative Care
  • surgical procedures
  • operative
  • intestines

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  • Contributors MT performed data extraction and wrote the manuscript. CL was involved in manuscript editing. HJM and SL were involved with manuscript editing and study development. LTG is the Senior Author, involved in the development of the study, and for supervising data collection, analysis, and manuscript editing.

  • Funding This work was supported by the Department of Medical Oncology at the University of Toronto.

  • Competing interests MT, CL, HJM, and LTG have nothing to disclose. SL reports grants from industry-sponsored trials, personal fees from Roche Holding AG, personal fees from GSK, personal fees from AstraZeneca, personal fees from Merck & Co, outside the submitted work. No payment was received for the current manuscript.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All de-identified participant data has been reported in the article.