http://archsurg.jamanetwork.com/ en-us Wed, 05 Jun 2013 00:00:00 GMT Wed, 05 Jun 2013 16:44:58 GMT Silverchair editor@archsurg.jamanetwork.com webmaster@archsurg.jamanetwork.com http://archsurg.jamanetwork.com/article.aspx?articleID=1693119 Wed, 05 Jun 2013 00:00:00 GMT Winner M, Mooney SJ, Hershman DL, et al. <span class="paragraphSection"><div class="boxTitle">Importance</div>Research has been limited on the incidence, mechanisms, etiology, and treatment of symptoms that require palliation in patients with terminal cancer. Bowel obstruction (BO) is a common complication of advanced abdominal cancer, including colon cancer, for which small, single-institution studies have suggested an incidence rate of 15% to 29%. Large population-based studies examining the incidence or risk factors associated with BO in cancer are lacking.<div class="boxTitle">Objective</div>To investigate the incidence and risk factors associated with BO in patients with stage IV colon cancer.<div class="boxTitle">Design and Setting</div>Retrospective cohort, population-based study of patients in the Surveillance, Epidemiology, and End Results and Medicare claims linked databases who were diagnosed as having stage IV colon cancer from January 1, 1991, through December 31, 2005.<div class="boxTitle">Patients</div>Patients 65 years or older with stage IV colon cancer (n = 12 553).<div class="boxTitle">Main Outcomes and Measures</div>Time to BO, defined by inpatient hospitalization for BO. We used Cox proportional hazards regression models to determine associations between BO and patient, prior treatment, and tumor features.<div class="boxTitle">Results</div>We identified 1004 patients with stage IV colon cancer subsequently hospitalized with BO (8.0%). In multivariable analysis, proximal tumor site (hazard ratio, 1.22 [95% CI, 1.07-1.40]), high tumor grade (1.34 [1.16-1.55]), mucinous histological type (1.27 [1.08-1.50]), and nodal stage N2 (1.52 [1.26-1.84]) were associated with increased risk of BO, as was the presence of obstruction at cancer diagnosis (1.75 [1.47-2.04]). A more recent diagnosis was associated with decreased risk of subsequent obstruction (hazard ratio, 0.84 [95% CI, 0.72-0.98]).<div class="boxTitle">Conclusions and Relevance</div>In this large population of patients with stage IV colon cancer, BO after diagnosis was less common (8.0%) than previously reported. Risk was associated with site and histological type of the primary tumor. Future studies will explore management and outcomes in this serious, common complication.</span> 1 7 10.1001/jamasurg.2013.1 http://archsurg.jamanetwork.com/article.aspx?articleID=1693119 http://archsurg.jamanetwork.com/article.aspx?articleID=1693121 Wed, 05 Jun 2013 00:00:00 GMT Krouse RS. <span class="paragraphSection">Malignant bowel obstruction (MBO) is an important palliative care problem for many patients with colon cancer. Malignant BO may be due to the primary tumor, to metastatic disease, or to previous surgical intervention leading to adhesions or internal hernia. Although many reports have examined MBO in the setting of colon cancer, the true incidence and the outcomes remain unknown. Winner and colleagues attempt to address this deficiency by using the Surveillance, Epidemiology, and End Results and Medicare claims linked databases.</span> 1 1 10.1001/jamasurg.2013.15 http://archsurg.jamanetwork.com/article.aspx?articleID=1693121