IngentaConnect Aggressive initial surgery for chronic radiation enteritis: long-...

Abstract:

Objective

One third of patients with chronic radiation enteritis will require surgery. There is, however, no consensus on the best surgical strategy. The long-term results of intestinal resection vs a `conservative' procedure, including stoma, bypass, and/or adhesiolysis, were reviewed with special reference to reoperation rates and the ultimate need for long-term parenteral nutrition. Patients and methods

Forty-four patients operated for chronic radiation enteritis were divided into two groups: Group I resection (n = 21) and Group II conservative (n = 23). Twenty patients had received preoperative total parenteral nutrition, 16 (76%) in the resection group vs four (17%) in the conservative group (P < 0.001). In the resection group, intestinal resection was combined with a stoma in six patients. In the conservative group, 10 patients underwent adhesiolysis, five a bypass procedure, and eight diverting stoma. Results

Post-operative mortality was similar in both groups (9.5% vs 8.5%). Mean follow up was 53 and 55 months for Group I and Group II, respectively. The reoperation rate was significantly lower in Group I: 9 (47%) vs 19 (86%), P < 0.01. Although not significant, the ultimate need for long-term parenteral nutrition rate was lower in Group I than in Group II: 6 (32%) vs 10 (48%). Conclusion

Resection resulted in better treatment outcomes than `conservative' surgery for chronic radiation enteritis.

Keywords: Radiation enteritis; intestinal resection; bypass; diverting stoma; parenteral nutrition

Document Type: Original article

DOI: 10.1046/j.1463-1318.1999.00037.x

Affiliations: 1: Department of Surgery, Lariboisière Hospital, Paris, France 2: Department of Gastroenterology, Saint-Lazare Hospital, Paris, France

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Aggressive initial surgery for chronic radiation enteritis: long-term results of resection vs non-resection in 44 consecutive cases