TPN for malignant bowel obstruction – pro
Management of malignant bowel obstruction is difficult and frought with uncertainties. There is no clear evidence nor consensus on the surgical management of patients with advanced cancer. Surgery can only benefit selected patients with mechanical obstruction and should not be routine practice. Non-surgical treatment includes, bowel decompression, control of nauseas and hydration or intravenous nutrition. With these measures, patients can be maintained with a reasonable quality of life for many months. Multiple studies suggest that outcomes of surgical and non-surgical treatment are comparable.
There is controversy regarding the use of total parenteral nutrition (TPN) in individuals with metastatic malignancies. Studies show that patients with small bowel obstruction and metastatic malignancy may benefit from TPN as demonstrated by prolonged survival rate longer than 60 d. To provide or not to provide life-prolonging TPN in terminal situations becomes an ethical and moral question and it is a hotly debated issue in palliative care and ethics literature.
http://www.sign.ac.uk/guidelines/fulltext/75/section8.html
http://www.cks.library.nhs.uk/palliative_care_nausea_vomit/in_summary/malignant_bowel_obstruction
Vinaya Potluri, MD and Donna S. Zhukovsky, MD, FACP Recent Advances in Malignant Bowel Obstruction: An Interface of Old and New Current Pain and Headache Reports 2003, 7:270-278
J. R. Hardy (2000) Medical management of bowel obstruction British Journal of Surgery 87 (10), 1281–1283.
DUERKSEN Donald R. et al, Is There a role for TPN in terminally ill Patients with bowel obstruction? Nutrition (Nutrition) 2004, vol. 20, no9, pp. 760-763