Surgical, non-surgical and clinical management of malignant bowel obstruction in ovarian cancer

Malignant bowel obstruction (MBO) is a clinical syndrome in which mechanical, functional, or radiologically demonstrable obstruction occurs in the gastrointestinal tract beyond the ligament of Treitz in the presence of a malignancy. It tends to recur and is rather a challenging and often terminal event in cases of advanced cancer. It affects almost half of the patients with ovarian cancer during the course of the disease and is associated with significant morbidity. The management often requires multidisciplinary decision-making considering the patient’s performance status, disease extent, prior treatments and goals of care to optimize patient outcomes and quality of life. Treatment options include surgical and non-surgical methods. In carefully selected patients, surgical intervention is often associated with better outcomes in terms of a symptoms-free period and overall survival, particularly when conservation treatment fails. When surgery is not feasible, non-surgical interventions such as the use of nasogastric tubing, percutaneous gastrostomy and drugs (octreotide, Gastrografin and dexamethasone) provide varying improvements in symptoms. Early involvement of the palliative care team in the management of MBO plays a crucial role in patient counseling and best supportive care. In this review article, we synthesized published evidence by performing a literature search of PubMed/MEDLINE, Embase, Scopus and the Cochrane Library. This article highlights the epidemiology, pathophysiology and various evidence-based surgical and non-surgical treatment strategies of malignant bowel obstruction in patients with advanced ovarian cancer.