Challenges in Surgical Management of Abdominal Pain in the Neutropenic Cancer Patient.
Badgwell, Brian D. MD *; Cormier, Janice N. MD, MPH *; Wray, Curtis J. MD *; Borthakur, Gautam MBBS +; Qiao, Wei MS ++; Rolston, Kenneth V. MD [S]; Pollock, Raphael E. MD, PhD *
Annals of Surgery.
248(1):104-109, July 2008.
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Background: Abdominal pain in neutropenic cancer patients presents a unique clinical challenge for surgeons. The purposes of this retrospective study were to characterize the clinicopathologic factors associated with the presentation of neutropenia and abdominal pain, examine the treatment strategies used, and define associated outcomes for these patients.
Methods: We identified patients with concomitant neutropenia (absolute neutrophil count <1000 cells/[mu]L) and abdominal pain who had been evaluated by surgical oncologists over a period of more than 6 years. A Cox proportional hazards regression model was used to analyze the association between clinicopathologic factors and overall survival time.
Results: Sixty patients were included in this analysis. After our clinical and radiographic evaluations, we determined that the most frequent causes of the abdominal pain were neutropenic enterocolitis (28%) and small bowel obstruction (12%); the cause remained uncertain in 35%. Surgical interventions had been performed in 9 patients. The 30- and 90-day mortality rates for all patients were 30% and 52%, respectively. Multivariate analysis revealed that severe sepsis, a relatively long duration of neutropenia, and the lack of surgical intervention were significant adverse prognostic factors for overall survival.
Conclusions: Abdominal pain as a symptom in neutropenic patients continues to be a diagnostic and therapeutic challenge and is associated with a high mortality rate. Based on our results, we conclude that efforts should focus on improving neutrophil counts and on treating the frequent and serious comorbidities found in these patients. Surgery should be delayed, when possible, to allow for neutrophil recovery.
(C) 2008 Lippincott Williams & Wilkins, Inc.