Background: The purpose of this study was to identify preoperative clinical and radiographic factors relevant to treatment selection and outcomes in patients with advanced cancer presenting with bowel obstruction. Methods: Clinical and radiographic data were retrospectively obtained from records of inpatients with suspected bowel obstruction referred for palliative surgical consultation (2000-2006). Patients were stratified according to site of obstruction: gastric outlet obstruction (GOO), small bowel obstruction (SBO), and large bowel obstruction (LBO). We utilized the Cox proportional hazards model to identify preoperative clinical and radiologic variables associated with overall survival (OS). Results: Of 191 patients, the site of obstruction was classified as GOO in 41 (21%), SBO in 122 (64%), and LBO in 28 (15%). Almost half of the patients (47%) had received systemic therapy in the 6 weeks prior to evaluation. The most common sites of disease identified on imaging included abdominal visceral metastases (37%), carcinomatosis/sarcomatosis (46%), and an intact primary tumor or recurrence (31%). Most patients (62%) exhibited 2 or more sites of disease on imaging. Treatment strategies included nonoperative/nonprocedural management in 41% (n=79), endoscopic/interventional radiology procedures in 25% (n=48), and surgery in 34% (n=64). Median OS for the cohort was 3.5 months (95% confidence interval [CI]: 2.7-4.6). Median OS for GOO, SBO, and LBO was 2.7 (95% CI: 1.7-4.1), 3.5 (95% CI: 2.5-4.9), and 7.0 (95% CI: 2.1-11) months, respectively (p=0.17). Adverse prognostic factors for OS included endoscopic/interventional radiology procedures and ≥3 radiologically evident sites of disease. Conclusions: OS, although low, was not significantly different among GOO, SBO, and LBO. Single sites of disease identified on imaging were not associated with OS, although multiple sites of disease were associated with diminished OS. © Copyright 2011, Mary Ann Liebert, Inc.