Radiation-induced bowel complications: laparoscopic versus open staging of gynecologic malignancy.
OBJECTIVE
To evaluate whether the type of surgical approach used to stage gynecologic malignancies influences the risk of developing nonrectal radiation-induced intestinal injury (NRRIII) in patients who subsequently receive adjuvant radiotherapy.


METHODS
A prospectively entered database was queried for all women with either primary or recurrent gynecologic malignancy who underwent external-beam radiation therapy ± brachytherapy and who had prior abdominopelvic surgery at our institution. Univariate and multivariate analysis of variables potentially affecting the risk of developing significant bowel toxicity (defined as grade 2 or more according to Radiation Therapy Oncology Group scoring) were performed.


RESULTS
One hundred fifty-nine patients were identified. The site of primary tumor was the cervix in 61 (38%) patients and the corpus uteri in the remaining patients (98, 62%). Treatment was delivered with a combination of external-beam and intracavitary irradiation to 50 (31.4%) patients, and 109 (68.6%) patients received only external-beam irradiation. Staging procedures were performed by open surgery in 93 (58.5%) patients, whereas laparoscopy was the surgical approach of choice in 66 (41.5%) women. Fifteen patients (9.4%) developed grade 2 or greater NRRIII, at median latency of 10 months (range 3-64 months); six were diagnosed as grade 3 complications requiring surgery, and three developed grade 4 complication. Multiple regression revealed an independent protective effect of pretreatment laparoscopic staging against the risk of developing both grade ≥2 and grade ≥3 NRRIII.


CONCLUSIONS
Notwithstanding potential limitations of nonrandomized study design, our findings suggest that the benefits of minimal-access surgery used to perform staging procedures may translate into long-term reduction in radiation-induced bowel injury.
Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy. fabio.ghezzi@uninsubria.it
Fabio
F
Ghezzi
Antonella
A
Cromi
Maurizio
M
Serati
Stefano
S
Uccella
Giorgio
G
Formenti
Giorgio
G
Bogani
Paolo
P
Vanoli
D001918:Brachytherapy / Q000009:adverse effects*; D003131:Combined Modality Therapy; D016889:Endometrial Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007421:Intestine, Small / Q000293:injuries* / Q000528:radiation effects*; D010535:Laparoscopy; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D011832:Radiation Injuries; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy* / Q000601:surgery