Surgical complications of oncological treatments: A narrative review

Gastrointestinal complications are common in patients undergoing various forms of cancer treatments, including chemotherapy, radiation therapy, and molecular-targeted therapies. Surgical complications of oncologic therapies can occur in the upper gastrointestinal tract, small bowel, colon, and rectu...

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Published inWorld journal of gastrointestinal surgery Vol. 15; no. 6; pp. 1056 - 1067
Main Authors Fico, Valeria, Altieri, Gaia, Di Grezia, Marta, Bianchi, Valentina, Chiarello, Maria Michela, Pepe, Gilda, Tropeano, Giuseppe, Brisinda, Giuseppe
Format Journal Article
LanguageEnglish
Published United States Baishideng Publishing Group Inc 27.06.2023
Subjects
Minireviews
Chemotherapy
Radiotherapy
Complications
Gastrointestinal bleeding
Bowel perforation
Cancer
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Summary:Gastrointestinal complications are common in patients undergoing various forms of cancer treatments, including chemotherapy, radiation therapy, and molecular-targeted therapies. Surgical complications of oncologic therapies can occur in the upper gastrointestinal tract, small bowel, colon, and rectum. The mechanisms of action of these therapies are different. Chemotherapy includes cytotoxic drugs, which block the activity of cancer cells by targeting intracellular DNA, RNA, or proteins. Gastrointestinal symptoms are very common during chemotherapy, due to a direct effect on the intestinal mucosa resulting in edema, inflammation, ulceration, and stricture. Serious adverse events have been described as complications of molecular targeted therapies, including bowel perforation, bleeding, and pneumatosis intestinalis, which may require surgical evaluation. Radiotherapy is a local anti-cancer therapy, which uses ionizing radiation to cause inhibition of cell division and ultimately lead to cell death. Complications related to radiotherapy can be both acute and chronic. Ablative therapies, including radiofrequency, laser, microwave, cryoablation, and chemical ablation with acetic acid or ethanol, can cause thermal or chemical injuries to the nearby structures. Treatment of the different gastrointestinal complications should be tailored to the individual patient and based on the underlying pathophysiology of the complication. Furthermore, it is important to know the stage and prognosis of the disease, and a multidisciplinary approach is necessary to personalize the surgical treatment. The purpose of this narrative review is to describe complications related to different oncologic therapies that may require surgical interventions.
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Corresponding author: Giuseppe Brisinda, MD, Professor, Surgeon, Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, 8 Largo Agostino Gemelli, Rome 00168, Italy. gbrisin@tin.it
Author contributions: Fico V and Altieri GM equally contributed to the drafting of the manuscript; Fico V, Altieri G, Tropeano G, Di Grezia M, Bianchi V, Chiarello MM, and Brisinda G designed the research; Bianchi V, Pepe G, Fico V, and Altieri G performed the research; Fico V, Altieri G, Tropeano G, and Di Grezia M analyzed the data; Fico V, Altieri G, Pepe G, and Brisinda G wrote the paper; all the authors read and approved the final manuscript.
ISSN:1948-9366
1948-9366
DOI:10.4240/wjgs.v15.i6.1056