Recurrence of Radiation Enterocolitis within 1 Year is Predictive of 5-Year Mortality in Surgical Cases of Radiation Enterocolitis: Our 18-Year Experience in a Single Center

• Published in: World journal of surgery Vol. 34; no. 10; pp. 2470 - 2476
• Main Authors: Chen, Ming-Cheng, Chiang, Feng-Fan, Wang, Hwei-Ming, Chen, Joe-Bin, Chao, Te-Hsin, Ma, Hsiu-Feng
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.10.2010; Springer‐Verlag; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Biological and medical sciences; Cardiac Surgery; Chronic Disease; Disease Progression; Enterocolitis - etiology; Enterocolitis - mortality; Enterocolitis - surgery; Epidemiology; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; General Surgery; Great Adverse Effect; Humans; Hyperbaric Oxygen Therapy; Inflammatory Bowel Disease; Longe Latency Period; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Other diseases. Semiology; Prognosis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Radiation Injuries - complications; Radiation Injuries - mortality; Rapid Disease Progression; Recurrence; Retrospective Studies; Risk Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery; Survival Analysis; Thoracic Surgery; Vascular Surgery; Great Adverse Effect; Rapid Disease Progression; Inflammatory Bowel Disease; Longe Latency Period; Hyperbaric Oxygen Therapy; Medicine; Center; Relapse; Treatment; Surgery; Mortality; Radiation; Digestive diseases; Intestinal disease; Enterocolitis; Predictive factor; Epidemiology
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-010-0645-7

Background Pelvic irradiation is commonly used in the treatment of pelvic malignancies. Chronic radiation enterocolitis is the most serious complication resulting from such treatment, and it frequently requires surgery. The prognosis for patients after surgery remains ill-defined. We conducted a retrospective study to identify risk factors associated with mortality for patients who received surgery for chronic radiation enterocolitis. Methods From 1985 to 2009, a total of 89 patients were diagnosed as having chronic radiation enterocolitis in Taichung Veterans General Hospital. The chart records of 35 surgical and 54 nonsurgical patients were reviewed. A total of 21 candidate risk factors were selected from (1) those related to rapid disease progression (recurrence within 1 year, reoperation within 1 year, short latency), (2) those mentioned in published series (diabetes mellitus, history of smoking, history of abdominopelvic surgery), and (3) other risk factors that might adversely affect outcomes (older age, higher radiation dosage, longer latency period). Factors with p  < 0.1 in univariate analysis were subjected to multivariate analysis to identify those that were independent risk factors. Results Surgical patients were significantly older (65.09 vs. 61.61 years, p  = 0.011), had a longer latency period (17.08 vs. 8.09 months, p  = 0.037), and were associated with a higher percentage of radiation uropathy (54.28 vs. 12.96%, p  < 0.0001) than nonsurgical patients. There was no difference in radiation dosage between surgical and nonsurgical cases ( p  = 0.152). Recurrence of radiation enterocolitis within 1 year following surgery ( p  = 0.022), older age ( p  = 0.002), and uncured cancer ( p  = 0.001) were identified as independent risk factors for poor overall survival after surgery. All patients (100%) who had recurrent radiation enterocolitis within 1 year of surgery died within 5 years of recurrence. Conclusions The surgical cases were older, had a longer latency period, and had a higher percentage of radiation uropathy .Recurrence of radiation enterocolitis within 1 year after surgery, older age, and uncured cancer were independent risk factors associated with mortality for patients who received surgery for chronic radiation enterocolitis.