Total | Surgical oncologists | Acute care surgeons | P value | |
Case 1: a 50-year-old man with colon cancer 36 months from resection and adjuvant chemotherapy with a single point of obstruction in the terminal ileum. He has a single, 3 cm metastatic lesion in his liver, but no other metastatic disease. | ||||
Base scenario | 94.94 (4.70±0.64) | 95.80 (4.83±0.48) | 94.42 (4.62±0.71) | 0.587 |
Multiple hepatic metastases | 82.91 (4.16±0.97) | 91.60 (4.48±0.72) | 77.66 (3.97±1.04) | 0.001 |
Pulmonary metastases | 71.84 (3.87±1.16) | 84.87 (4.31±0.83) | 63.96 (3.60±1.24) | <0.001 |
Shorter disease-free interval | 86.08 (4.29±0.84) | 87.39 (4.39±0.78) | 85.28 (4.23±0.87) | 0.599 |
Omental metastases | 63.92 (3.68±1.11) | 78.15 (4.05±0.95) | 55.33 (3.46±1.15) | <0.001 |
Pancreatic adenocarcinoma | 46.84 (3.22±1.24) | 47.06 (3.24±1.22) | 46.70 (3.22±1.26) | 0.951 |
Case 2: a 45-year-old woman with epithelial ovarian cancer 36 months from optimal debulking and adjuvant chemotherapy with a single point of obstruction in the small bowel from carcinomatosis. She has three peritoneal implants, but no other metastatic disease. | ||||
Base scenario | 74.48 (3.97±1.12) | 90.18 (4.29±0.86) | 64.61 (3.60±1.19) | <0.001 |
Ascites present | 57.24 (3.41±1.19) | 74.11 (3.81±1.04) | 46.63 (3.16±1.21) | <0.001 |
Multiple areas of obstruction | 22.76 (2.54±1.17) | 26.79 (2.65±1.13) | 20.22 (2.48±1.18) | 0.194 |
2nd episode of obstruction | 24.48 (2.63±1.14) | 25.00 (2.63±1.07) | 24.16 (2.65±1.18) | 0.871 |
Shorter disease-free interval | 47.59 (3.24±1.13) | 50.00 (3.29±1.03) | 46.07 (3.22±1.18) | 0.514 |
Melanoma | 73.10 (3.88±1.15) | 87.50 (4.27±0.99) | 64.04 (3.63±1.19) | <0.001 |
Case 3: a 62-year-old woman with a carcinoid tumor 48 months from resection of an isolated mesenteric mass with a single point of obstruction in the jejunum from an unresectable central mesenteric mass. | ||||
Base scenario | 83.88 (4.21±0.93) | 90.99 (4.50±0.74) | 79.01 (4.01±0.99) | 0.008 |
Stable hepatic metastases | 75.09 (3.94±1.00) | 87.39 (4.33±0.81) | 66.67 (3.67±1.03) | <0.001 |
2nd episode of obstruction | 44.69 (3.22±1.11) | 54.95 (3.41±1.03) | 37.65 (3.08±1.15) | 0.005 |
Shorter disease-free interval | 32.97 (2.82±1.23) | 36.94 (2.91±1.25) | 30.25 (2.76±1.21) | 0.248 |
Multiple areas of obstruction | 32.60 (2.90±1.15) | 39.64 (3.09±1.12) | 27.78 (2.78±1.15) | 0.04 |
All patients were described as being otherwise healthy with good functional status. Patients had no signs of peritonitis or other indications for emergent surgery, although participants were informed that the obstruction would not resolve with conservative management. Responses reported as percent responding ‘likely’ or ‘very likely’ to offer an operation (mean response on the 5-point Likert scale±SD). Full case scenarios are shown in online supplemental file 1.