Medical diagnosis and treatment of malignant bowel obstruction
Ma Huaixing, Li Suyi
Department of Tumor Nutrition and Metabolic Therapy, the First Affiliated Hospital of University of Science and Technology of China(West District),Hefei 230031, Anhui, China
Abstract Malignant bowel obstruction is one of the common complications of advanced tumors. The treatment is mainly based on comprehensive medical methods. Understanding the pathophysiological mechanism (including “uncoordinated peristalsis-tissue edema-uncoordinated peristalsis” and “secretion-expansion-secretion” vicious circle), clarify the classification and subtype of obstruction and completing the systematic evaluation of oncology (including general conditions, organ function, oncology evaluation, nutritional metabolism and intestinal barrier function), are the prerequisites for its effective treatment. The principle and purpose of treatment are to minimize or even relieve the bodys tumor load, to improve or cure the adverse symptoms, signs and intestinal dysfunction caused by intestinal obstruction, to correct the state of water and electrolyte disorders and nutritional metabolism disorders, and ultimately to improve the patients quality of life and overall survival. Specific measures includes basic treatment, nutritional therapy and metabolic regulation, anti-inflammatory, reducing intestinal wall edema, inhibiting the secretion of glands in the digestive tract, repairing the intestinal barrier and preventing infection, anti-tumor etiology treatment and exercise therapy, psychological support. Anti-tumor etiological treatment is a clinical difficulty, because malignant bowel obstruction is often accompanied by malnutrition and poor general conditions, and it is difficult to tolerate conventional anti-tumor therapy. Anti-tumor therapy needs to take into account tumor factors, nutritional status and patients general conditions. Effective anti-tumor treatment is the basic guarantee for intestinal obstruction recanalization.
1.BOZZETTI F. The role of parenteral nutrition in patients with malignant bowel obstruction［J］. Support Care Cancer, 2019, 27(12):4393-4399.
2.PUJARA D, CHIANG Y J, CORMIER J N, et al. Selective approach for patients with advanced malignancy and gastrointestinal obstruction［J］. J Am Coll Surg, 2017, 225(1):53-59.
3.ARMAS I, BRANDO M, GUERREIRO I, et al. Incidental diagnosis of breast cancer in the pursuit of the treatment of intestinal obstruction［J］. Autops Case Rep, 2019, 9(1):e2018071.
4.ALESE O B, KIM S, CHEN Z, et al. Management patterns and predictors of mortality among US patients with cancer hospitalized for malignant bowel obstruction［J］. Cancer, 2015, 121(11):1772-1778.
5.李苏宜.慢性恶性机械性肠梗阻肿瘤内科处置思路及方法:文献复习和实践体会［C］.//中华医学会.2011全国肠内肠外营养学术会议论文集.2011:139-141.
6.DE BOER NL, HAGEMANS J A W, SCHULTZE B T A, et al. Acute malignant obstruction in patients with peritoneal carcinomatosis: The role of palliative surgery［J］. Eur J Surg Oncol, 2019, 45(3):389-393.
7.KROUSE R S. Malignant bowel obstruction［J］. J Surg Oncol, 2019, 120(1):74-77.
8.李世伟,马怀幸,李苏宜.ω-3多不饱和脂肪酸治疗癌性恶液质系统评价及荟萃分析［J］. 肠外与肠内营养, 2017, 24(1):28-32.
9.马怀幸,李苏宜. 肿瘤营养不良的内科治疗原理和原则［J］. 肿瘤学志, 2018, 24(9):849-855.
10.许佳伟,梁丙乾,郭建昇.奥曲肽联合常规治疗用于缓解恶性肠梗阻有效性与安全性的Meta分析［J］. 中国药房, 2019, 30(22):3138-3143.
11.KOH A, BCKHED F. From association to causality: the role of the gut microbiota and its functional products on host metabolism［J］. Mol Cell, 2020, 78(4):584-596.
12.TROHA K, AYRES J S. Metabolic adaptations to infections at the organismal level［J］. Trends Immunol, 2020, 41(2):113-125.
13.SCHULTHESS J, PANDEY S, CAPITANI M, et al. The short chain fatty acid butyrate imprints an antimicrobial program in macrophages［J］. Immunity, 2019, 50(2):432-445.e7.
14.YANG S M, LI S Y, YU H B, et al. Metronomic chemotherapy with 5-fluorouracil and cisplatin for inoperable malignant bowel obstruction because of peritoneal dissemination from gastric cancer［J］. Curr Oncol, 2016, 23(3):e248-e252.
15.PENSON R T, VALENCIA R V, CIBULA D, et al. Olaparib versus nonplatinum chemotherapy in patients with platinum-sensitive relapsed ovarian cancer and a germline BRCA1/2 Mutation (SOLO3):a randomized phase Ⅲ trial［J］. J Clin Oncol, 2020, 38(11):1164-1174.
16.WALSH C S. Latest clinical evidence of maintenance therapy in ovarian cancer［J］. Curr Opin Obstet Gynecol, 2020, 32(1):15-21.
17.BRAR G, SHAH M A. The role of pembrolizumab in the treatment of PD-L1 expressing gastric and gastroesophageal junction adenocarcinoma ［J］. Therap Adv Gastroenterol, 2019, 12:1756284819869767.
18.BANG Y J, KANG Y K, CATENACCI D V, et al. Pembrolizumab alone or in combination with chemotherapy as first-line therapy for patients with advanced gastric or gastroesophageal junction adenocarcinoma: Results from the phase Ⅱ nonrandomized KEYNOTE-059 study［J］. Gastric Cancer, 2019, 22(4):828-837.
19.OLIVEIRA A F, BRETES L, FURTADO I. Review of PD-1/PD-L1 inhibitors in metastatic dMMR/MSI-H colorectal cancer［J］. Front Oncol, 2019, 9:396.
20.CHALABI M, CARDONA A, NAGARKAR D R, et al. Efficacy of chemotherapy and atezolizumab in patients with non-small-cell lung cancer receiving antibiotics and proton pump inhibitors: pooled post hocanalyses of the OAK and POPLAR trials［J］. Ann Oncol, 2020, 31(4):525-531.
