Surgical Management of Radiation Enterocolitis

Abstract

Background: Pelvic irradiation has been a popular therapy modality for treating cervical cancer for many years, and its usage in rectal cancer and prostate cancer cases is also on the rise. In this study we retrospectively analyzed cases of surgical management for complications after pelvic irradiation. We also discuss the issue of resection of diseased bowel and the safety of anastomosis. Methods: From 1989 to 2007, a total of 31 patients in our hospital underwent gastrointestinal tract surgery for complications of pelvic irradiation and were enrolled in this study. A retrospective review was conducted for demographic data, preoperative status, operative strategy and recurrence of radiation enterocolitis. Results: For resection procedures, the mean length of hospital stay was 38.8 days and 18.8 days for diversion procedures (p=0.003). 21(58%) patients underwent resection procedures, and 15 (42%) patients underwent diversion procedures. The complication rate was 57% for resection procedures and 13% for diversion procedures (p=0.002). The mortality rate was 10% for resection procedures and 0 for diversion procedures (p=0.492). The total two-year recurrence rate for symptomatic radiation enterocolitis was 25%, and the re-operation rate was 22%. There was no significant difference in the recurrence rate and re-operation rate between resection procedures and diversion procedures. There was also no significant difference in the surgical outcome between the group with anastomosis and that without anastomosis. Conclusions: Surgery of radiation enterocolitis is associated with significant morbidity and mortality rates. Conservative procedures, such as bypass, stoma and stricturoplasty, should be considered for patients who are poor surgical candidates. Anastomosis did not increase surgical morbidity or mortality rates.