Frequency and Surgical Management of Chronic Complications Related to Pelvic Radiation

• Published in: Archives of surgery (Chicago. 1960) Vol. 143; no. 1; pp. 46 - 52
• Main Authors: Turina, Matthias, Mulhall, Aaron M, Mahid, Suhal S, Yashar, Catheryn, Galandiuk, Susan
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 01.01.2008
• Subjects: Adult; Aged; Biological and medical sciences; Chronic Disease; Chronic illnesses; Cohort Studies; Colorectal cancer; Colorectal Neoplasms - radiotherapy; Comparative analysis; Disease management; Dose-Response Relationship, Radiation; Epidemiology; Female; General aspects; Humans; Incidence; Male; Medical sciences; Middle Aged; Pelvis - radiation effects; Prognosis; Prostatic Neoplasms - radiotherapy; Radiation Injuries - diagnosis; Radiation Injuries - epidemiology; Radiation Injuries - surgery; Radiation therapy; Radiotherapy Dosage; Radiotherapy, Adjuvant; Retrospective Studies; Risk Assessment; Severity of Illness Index; Survival Analysis; Treatment Outcome; Uterine Cervical Neoplasms - radiotherapy; Medicine; Chronic; Clinical management; Treatment; Pelvic cavity; Surgery; Radiation; Complication; Frequency
• ISSN: 0004-0010; 2168-6254; 1538-3644; 2168-6262
• DOI: 10.1001/archsurg.2007.7

HYPOTHESIS Refractory complications from pelvic radiotherapy often require surgical treatment. Their management may be dictated by the primary tumor, radiation dose, and type and combination of radiation injuries, and may require transient diversion in most cases to guarantee good outcomes. DESIGN Retrospective 10-year cohort analysis compared with statewide epidemiologic data. PATIENTS During a 10-year period, 14 791 patients in Kentucky were treated with pelvic radiotherapy. Forty-eight were referred to a university colorectal surgical unit for evaluation of refractory radiotherapy complications that had failed conservative medical management. MAIN OUTCOME MEASURES Epidemiologic statewide data were compared with hospital data regarding the treatment and outcome of patients with refractory pelvic radiotherapy complications. RESULTS Twenty-five patients had received radiotherapy for colorectal carcinoma, 10 for prostate cancer, 7 for carcinoma of the cervix, and 6 for other tumors. Patients presented with 1 or more complications, including radiation enteritis (60%), strictures (53%), fistulae (17%), nonhealing wounds (15%), and de novo cancers in radiated fields (10%). Low anastomotic strictures (10%) were initially treated by dilation under sedation. Six patients (12%) ultimately required permanent diversion. All radiation-induced fistulae required an operation. CONCLUSIONS Determining the proper treatment requires careful judgment and assessment of the degree and type of injury, patient anatomy, and sphincter function. Patients presenting with colorectal anastomotic and primary bowel strictures as their main complication had the best results, while most patients with severe radiation enteritis and very distal strictures required permanent diversion.Arch Surg. 2008;143(1):46-52-->