Surgical therapy of radiation-induced lesions of the colon and rectum.
Thirty-six operations for late sequelae of radiotherapy were carried out in 31 patients from 1971 to 1986. The most frequent indications for surgery were stricture (58 percent) and fistula (29 percent). In the first 8 year period from 1971 through 1978, 13 of 14 operations were diversions (colostomy or by-pass). From 1979 through 1986, a more aggressive approach prevailed. Only 32 percent of the operations were diversions. This more aggressive strategy was accompanied by a decrease of the postoperative mortality rate from 21 percent through 1978 to 0 in the later period. The overall complication rate was 23 percent. Complications were relatively more frequent after two-layer sutured or stapled anastomoses and after resection or fistula closure without temporary colostomy. We conclude that in radiation-induced colonic and rectal lesions, diversion should be performed in patients with unproved cure of disease or tumor persistence. Resection and fistula closure can be carried out safely, and a temporary colostomy is strongly recommended.
Miholic
J
J
II. Chirurgische Universitätsklinik, Allgemeines Krankenhaus, Vienna, Austria.
Schwarz
C
C
Moeschl
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects; D002277:Carcinoma / Q000150:complications / Q000532:radiotherapy; D003110:Colonic Neoplasms / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D003125:Colostomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011471:Prostatic Neoplasms / Q000150:complications / Q000532:radiotherapy; D011878:Radiotherapy / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D014594:Uterine Neoplasms / Q000150:complications / Q000532:radiotherapy