Laparoscopic insertion of pelvic tissue expander to prevent radiation enteritis prior to radiotherapy for prostate cancer

Gary D Mckay,Daniel R Kozman,Karen Wong

doi:10.1186/1748-717x-6-47

Gary D Mckay, Daniel R Kozman + Show 1 more

Open Access

https://doi.org/10.1186/1748-717x-6-47

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Abstract

Radiation enteritis is a significant complication of external beam radiotherapy (EBRT) to the pelvis, particularly in patients having high dose radiotherapy (>80 Gy) and in those with a low pelvic peritoneal reflection allowing loops of small bowel to enter the radiation field. Laparoscopic insertion and subsequent removal of a pelvic tissue expander before and after external beam radiotherapy is a relatively convenient, safe and effective method for displacing loops of bowel out of the pelvis. We report on a patient with prostate cancer who ordinarily would not have been a candidate for EBRT due to loops of bowel low in the pelvis. With laparoscopic insertion and subsequent removal of a tissue expander, he was able to have radiotherapy to the prostate without developing radiation enteritis.

Highlights

Prostate cancer is the second most common cancer in men
The very high doses of 80 Gy radiotherapy required for prostate cancer, which is double that given for most other pelvic malignancies, puts those patients with a low peritoneal reflection and lowlying loops of small bowel in the pelvis, at particular risk of radiation enteritis
Laparoscopic insertion and subsequent removal of a tissue expander before and after radiotherapy is a relatively convenient and minimally invasive procedure that may be an option for displacing loops of bowel from the radiation field

Summary

Introduction

Prostate cancer is the second most common cancer in men. With the increasing use of primary radiotherapy for prostate cancer and improved survival, chronic radiation enteritis is an increasing problem occurring in over 20% of patients[1]. Laparoscopic insertion and subsequent removal of a tissue expander before and after radiotherapy is a relatively convenient and minimally invasive procedure that may be an option for displacing loops of bowel from the radiation field. Case Presentation The patient was a 75 year old man with prostate cancer, confirmed by FNA to investigate a raised PSA He had stage 2 disease with a Gleason score of 3+4, and required primary radiotherapy. Subsequent CT confirmed adequate placement of the expander device in the pelvis with loops of bowel well out of the pelvis and the planned radiation field (Figure 6). His recovery was uneventful being discharged home without complication after opening his bowels.

Discussion

Findings

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