Multidisciplinary ambulatory management of malignant bowel obstruction (MAMBO) program in patients with advanced gynecological cancers: A prospective study

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology Pub Date : 2025-10-09 DOI:10.1016/j.ygyno.2025.09.012

V. Garg , E. Armstrong , A. Celeste , C. Wang , A. Shukla , A. Tesfu , O. Odujoko , A. Madariaga , Y.C. Lee , L. Wang , H. Alqaisi , P. Soberanis , B. Grant , D. Braik , T. Chawla , E. Shlomovitz , A. Veneziani , N. Dhani , R. Grant , N. Jivraj , S. Lheureux

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引用次数: 0

Abstract

Objectives

This prospective study aimed to assess the feasibility of a risk-stratified, multidisciplinary ambulatory approach for managing malignant bowel obstruction (MBO) in patients with advanced gynecological cancer.

Methods

A clinical risk-based MBO triage system was implemented by incorporating bowel function assessments, management regimes, and educational tools. An interdisciplinary team (IDT) guided treatment decisions. At risk patients received proactive management through nursing phone calls for up to 4 weeks, while patients with MBO continued proactive management for up to 8 weeks based on symptom resolution. The primary endpoint was the ratio of days alive and out of the hospital to days in the hospital within 60 days post-MBO diagnosis.

Results

92 patients (median age 62 years [range 31–83]) were enrolled. At enrollment, 49 % (n = 45) had MBO, and 51 % (n = 47) were at risk of MBO development. 7 % (n = 3) at-risk patients progressed to MBO in 4 weeks, while 93 % had symptom resolution with proactive outpatient management.

Overall, 62 % (n = 57) of patients developed MBO during study period. Among these, 93 % (n = 53) needed inpatient care, with a median stay of 12.5 days (range 0–57) in the first 60 days. Median OS after MBO was 5.7 months (95 % CI, 3.6–8.4). The median of hospital-to-home ratio was 0.3 (range 0–19) within 60 days. MBO resolved in 42 % (n = 24) of the patients. Microbiome analysis showed lower Shannon diversity and species richness for MBO patients compared to those at risk.

Conclusion

This study confirms the feasibility of ambulatory management for MBO patients, using a risk-based MBO triage system guided by IDT.

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晚期妇科癌症患者恶性肠梗阻（MAMBO）项目的多学科门诊管理：一项前瞻性研究

目的：本前瞻性研究旨在评估风险分层、多学科门诊治疗晚期妇科癌症患者恶性肠梗阻（MBO）的可行性。方法采用基于临床风险的MBO分诊系统，结合肠功能评估、管理制度和教育工具。一个跨学科小组（IDT）指导治疗决策。有风险的患者通过护理电话接受了长达4周的积极管理，而MBO患者根据症状缓解持续了长达8周的积极管理。主要终点是mbo诊断后60天内存活和出院天数与住院天数之比。结果入选92例患者（中位年龄62岁[范围31-83]）。入组时，49% （n = 45）有MBO， 51% （n = 47）有发展成MBO的风险。7%的高危患者（n = 3）在4周内进展为MBO，而93%的患者在积极的门诊治疗下症状得到缓解。总体而言，62% （n = 57）的患者在研究期间发生了MBO。其中，93% （n = 53）需要住院治疗，前60天的中位住院时间为12.5天（范围0-57天）。MBO术后中位OS为5.7个月（95% CI, 3.6-8.4）。60天内的医院与家庭比率中位数为0.3（范围0-19）。42% （n = 24）患者的MBO得到缓解。微生物组分析显示，与高危人群相比，MBO患者的Shannon多样性和物种丰富度较低。结论采用IDT指导下基于风险的MBO分诊系统对MBO患者进行门诊管理是可行的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gynecologic oncology 医学-妇产科学

CiteScore

8.60

自引率

6.40%

发文量

1062

审稿时长

37 days

期刊介绍： Gynecologic Oncology, an international journal, is devoted to the publication of clinical and investigative articles that concern tumors of the female reproductive tract. Investigations relating to the etiology, diagnosis, and treatment of female cancers, as well as research from any of the disciplines related to this field of interest, are published. Research Areas Include: • Cell and molecular biology • Chemotherapy • Cytology • Endocrinology • Epidemiology • Genetics • Gynecologic surgery • Immunology • Pathology • Radiotherapy