title: Radiation therapy increases the risk of hepatobiliary complications in short bowel syndrome.
abstract: Patients developing short bowel syndrome (SBS) are at risk for hepatobiliary complications. Radiation enteritis and radiation-induced liver disease are potential complications of radiation therapy (XRT). The authors hypothesized that SBS patients with a history of abdominal XRT would be at increased risk for hepatobiliary complications.
  
  
  METHODS
  The authors reviewed 92 adult patients developing SBS as a complication of operation for malignancy (n = 37) and/or XRT (n = 55). Hepatobiliary disease was evaluated by liver function tests, radiologic imaging, endoscopy, and histologic studies.
  
  
  RESULTS
  Rectal cancer was the most frequent tumor in both groups (36% vs 35%). There were significantly more ovarian cancers (18% vs 3%, P < .05) in the radiation group and fewer desmoid tumors (0% vs 24%, P < .05). Intestinal remnant length was similar, but radiation patients more frequently had colon present (87% vs 62%, P < .05) and were less likely to have type I anatomy (33% vs 65%, P < .05). Radiation patients were less likely to be weaned off parenteral nutrition (PN; 16% vs 41%, P < .05). Cirrhosis/portal hypertension was more frequent in the radiation group (35% vs 11%, P < .05). Radiographic evidence of fatty liver, end-stage liver disease and the risk of cholelithiasis post-SBS were similar in both groups.
  
  
  CONCLUSIONS
  SBS patients with a history of XRT were more likely to develop cirrhosis and portal hypertension than SBS patients with malignancy alone. Radiation SBS patients were less likely to wean from PN despite more favorable intestinal anatomy.
authors.affiliation: University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA. jthompso@unmc.edu
authors.forename: Jon S
authors.initials: JS
authors.lastname: Thompson
authors.forename: Rebecca
authors.initials: R
authors.lastname: Weseman
authors.forename: Fedja
authors.initials: F
authors.lastname: Rochling
authors.forename: Wendy
authors.initials: W
authors.lastname: Grant
authors.forename: Jean
authors.initials: J
authors.lastname: Botha
authors.forename: Alan
authors.initials: A
authors.lastname: Langnas
authors.forename: David
authors.initials: D
authors.lastname: Mercer
mesh_terms: D000005:Abdomen / Q000528:radiation effects*; D000328:Adult; D000368:Aged; D002769:Cholelithiasis; D005260:Female; D018222:Desmoid Tumors / Q000209:etiology / Q000628:therapy; D005355:Fibrosis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D006975:Hypertension, Portal / Q000453:epidemiology / Q000209:etiology*; D007422:Intestines / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology* / Q000628:therapy; D010051:Ovarian Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D010288:Parenteral Nutrition; D011183:Postoperative Complications; D011878:Radiotherapy / Q000009:adverse effects*; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D012307:Risk Factors; D012778:Short Bowel Syndrome / Q000150:complications*; D055815:Young Adult