Clinical efficacy of laparoscopic surgery for pelvic radiation induced enteritis

Abstract

Objective To investigate the clinical efficacy of laparoscopic surgery for pelvic radiation induced enteritis (PRIE). Methods The retrospective cross-sectional study was conducted. The clinical data of 66 patients with PRIE who were admitted to the Nanjing General Hospital of Nanjing Military Command from January 2012 to December 2015 were collected. Laparoscopic surgery will be applied to patients based on patients′ clinical manifestations after completing relative examinations. Observation indicators: (1) surgical situations: surgical method, conversion to open surgery, reoperation, surgical incision length, grade of abdominal adhesions, surgical time, volume of intraoperative blood loss, duration of postoperative hospital stay; (2) occurrence of surgical complications; (3) follow-up situations. Follow-up using telephone interview was performed to detect patients′ survival and recurrence of PRIE up to April 2016. Measurement data with normal distribution were represented as ±s. Results (1) Surgical situations: ① of 59 patients with small intestinal obstruction, 11 underwent laparoscopic small intestinal resection or enterostomy, including 2 with conversion to open surgery due to dense adhesions, 1 due to uncertainty of tumor recurrence and 1 due to intestinal canal dilatation affected vision; 48 underwent laparoscopic resection of ileocecum, including 11 with conversion to open surgery due to dense adhesions, 2 due to iliac vessels injury and 4 due to injuries of sigmoid colon, rectum and bladder. Four patients with colonic obstruction and proctitis underwent laparoscopic colostomy, without conversion to open surgery. One patient received conversional open surgery and underwent intestinal resection of internal fistula+ exclusion of rectal stump due to intestine-rectum fistula induced dense adhesions. One patient with anal atresia underwent laparoscope-assisted resection of pelvic tissues and rectal stump. One patient with localized peritonitis underwent laparoscope-assisted ileostomy. ② Among 66 patients, 4 received reoperations, including 2 with cervical cancer and 2 with rectal cancer, reoperations of 4 patients were respectively caused by intestine-rectum fistula, rectovaginal fistula, anastomotic fistula and ostomy + stoma reversion. Of 4 patients with reoperations, 1 received conversion to open surgery due to dense adhesions and then underwent intestinal resection of internal fistula+ exclusion of rectal stump, 1 with rectovaginal fistula underwent laparoscopic colostomy, 1 with anastomotic fistula underwent resection and anastomosis of small intestine due to dense adhesions and 1 underwent laparoscopic ileostomy and stoma reversion. ③ Sixty-six patients received 70 operations, including 46 laparoscopic surgeries and 24 conversion to open surgeries. Surgical incision length and average length were respectively 3.0-6.0 cm, 4.0 cm in 46 laparoscopic surgeries and 8.0-25.0 cm, 15.5 cm in 24 conversion to open surgeries. Grade 0, 1, 2 and 3 of abdominal adhesions were detected respectively in 7, 13, 13, 13 laparoscopic surgeries and in 1, 1, 12, 10 conversion to open surgeries. Operation time, volume of intraoperative blood loss and duration of postoperative hospital stay were respectively (128±50)minutes, (108±56)mL, (30±15)days in 46 laparoscopic surgeries and (173±44)minutes, (222±105)mL, (38±19)days in 24 conversion to open surgeries. (2) Occurrence of surgical complications: 1 patient was complicated with bladder injury in 46 laparoscopic surgeries, and 2, 4 and 2 patients in 24 conversion to open surgeries were respectively complicated with bladder injury, colorectal injury and injury of right iliac vessels, they received intraoperative symptomatic treatment. Two, 3, 3, 6 and 1 patients were respectively complicated with pleural effusion, wound infection or dehiscence, venous catheter infection, anastomotic fistula and cholestatic cholecystitis after 46 laparoscopic surgeries. One, 5, 1, 4, 2 and 1 were respectively complicated with pleural effusion, wound infection or dehiscence, venous catheter infection, anastomotic fistula, cholestatic cholecystitis and abdominal wall hemorrhage after 24 conversion to open surgeries. They were improved by symptomatic treatment. (3) Follow-up situations: all the 66 patients were followed up for 4-50 months, with a median time of 26 months. During the follow-up, 3 patients died of intraperitoneal infection, short bowel syndrome and pulmonary infection, and 3 patients had PRIE. Conclusion The appropriate surgical method is selected based on clinical manifestations of patients, and laparoscopic surgery is safe and feasible for PRIE. Key words: Radiation enteritis; Intestinal obstruction; Surgical procedures, operative; Laparoscopy