Abstract 1378: Factors influencing survival in gynecologic oncology patients diagnosed with intestinal perforation and pneumatosis intestinalis.
Authors: Garg Gunjal , Pourbolghasem Shabnam , Zhou Gongfu , Powell Matthew A. , Thaker Premal H. , Hagemann Andrea R. , Wilkinson-Ryan Ivy , Massad L. Stewart , Mutch David G. 
Published: August 2014

Abstract
Objective: To investigate the potential factors associated with survival in gynecologic oncology patients diagnosed with intestinal perforation and pneumatosis intestinalis.
Methods: A retrospective chart review was performed of all gynecologic oncology patients with intestinal perforation and/or pneumatosis intestinalis at our institutionbetween 1995 and 2011. Factors influencing survival from time of diagnosis were analyzed using Kaplan-Meier method and Cox proportional hazard models.
Results: Forty-five patients met the study criteria. The median age was 59 years (range: 38-82 years). Surgery was performed in 28 patients (62%). Among the 17 patients (38%) managed conservatively, 9 (53%) were under hospice care and 8 had a contained perforation (47%). Overall mortality at 1, 3, 6, and 12 months was 27%, 40%, 49%, and 60%, respectively. The corresponding numbers in the surgery group were 14%, 29%, 32%, and 50%, and in the non-surgery group 47%, 59%, 76%, and 76%, respectively. Importantly, all 18 patients who died within the first 3 months had active cancer at time of diagnosis and CA125 levels were &lt;100 in only 4 of these. Conversely, CA125 levels &gt;100 were reported in only 2 patients of the 17 who lived longer than 12 months. Seven patients developed perforation after using bevacizumab. Of these, 3 were treated with surgery and 4 were managed conservatively. The three patients treated surgically died at 26 days, 56 days, and 58 days post-surgery. Of the 4 patients treated conservatively, one was still alive at last follow-up (2.7 years), the other three died at 3 days, 34 days, and 126 days after diagnosis. On univariate analysis, advanced stage disease, no cancer- directed surgery, receipt of &gt;3 chemotherapy regimens, active cancer at the time of perforation, conservative management of perforation, and CA125 &gt;100 were negatively associated with survival (p&lt;0.05). On multivariate analysis, only active cancer at diagnosis was independently predictive of mortality (HR: 7.31, 95%CI: 1.20-69.68).
Conclusions: Bowel perforation and pneumatosis intestinalis carry grave prognosis in patients with gynecologic cancers. Although surgical management is performed in patients with free intestinal leak, overall prognosis is poor and conservative management should be considered. The ultimate prognosis is most closely associated with the amount of cancer present at time of diagnosis and should be given due consideration to avoid aggressive surgical treatment in those unlikely to derive significant benefit.
Citation Format: Gunjal Garg, Shabnam Pourbolghasem, Gongfu Zhou, Matthew A. Powell, Premal H. Thaker, Andrea R. Hagemann, Ivy Wilkinson-Ryan, L. Stewart Massad, David G. Mutch. Factors influencing survival in gynecologic oncology patients diagnosed with intestinal perforation and pneumatosis intestinalis. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1378. doi:10.1158/1538-7445.AM2013-1378