October 1997

Invited Commentary

Author Affiliations

Department of Veterans Affairs Medical Center Minneapolis, Minn

Arch Surg. 1997;132(10):1097. doi:10.1001/archsurg.1997.01430340051007

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The authors address a common surgical dilemma in patients previously treated for cancer. There are 3 dimensions to the decisions: First, is the obstruction caused by benign adhesions, carcinomatosis, or intraluminal cancer? Second, is the obstruction partial, intermittent, high-grade total obstruction, or even strangulated? Finally, decisions to operate must also consider the patient's level of functioning, tumor burden, and estimated survival.

The authors clearly identified a subgroup (13%) that were more than 5 years from their cancer operation who all had benign causes of obstruction and did well. Also, results were relatively better in patients who had had genitourinary malignant neoplasms. Another guide is seen in Figure 3, where the odds of a benign obstructive process are higher in the 12 to 18 months after resection if extensive carcinomatosis was not present at the initial treatment.

This leaves the bulk of cases with less clear guides. How do we identify

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