A new laparoscopic method of bowel radio-protection before pelvic chemoradiation of locally advanced cervix cancers.
BACKGROUND
Chemoradiation therapy (CRT) has become the mainstay of locally advanced cervical carcinomas (LACC). However, the price to pay is a significant rate of both early and late colo-rectal toxicities, which may impact on survivors' quality of life. To reduce the incidence of such complications, we suggest a simple technique of pelvic radioprotection.


METHODS
An omental flap is created which is placed to fill the Douglas pouch to both increase the space between rectum and uterine cervix and prevent small bowel to fall in and to be exposed to radiation. In addition, a long sigmoid loop is retracted and fixed in the left paracolic gutter to prevent its irradiation as well.


RESULTS
From May 2011 to May 2012, 51 successive LACC patients were offered this procedure in addition of a laparoscopic staging. All but 2 with too small an omentum benefitted from omentoplasty, while sigmoidopexy was performed in all but one patient with a long and free sigmoid loop. No immediate adverse effect was observed. The volume of retro-uterine omental flap averaged 7.17 ± 3.79 cm(3). Sequential measurements of the utero-rectal space throughout CRT duration showed a real and durable increase in the distance between these organs, resulting in a drop in the dose of irradiation to recto-sigmoid. With 10 ± 4.5-month median follow-up, we did not observe any rectal or small bowel early or late adverse effects of CRT.


CONCLUSIONS
Although this series is preliminary, this simple procedure, feasible by laparoscopy (or laparotomy), seems effective to prevent recto-sigmoid as well as small bowel from radio-induced complications due to pelvic CRT.
Department of Gynecologic Oncology, Centre Oscar Lambret, Lille, France, e-leblanc@o-lambret.fr.
E
E
Leblanc
F
F
Narducci
L
L
Bresson
J
J
Durand-Labrunie
S
S
Taieb
E
E
Vanlerenberghe
I
I
Farre
P
P
Nickers
D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000379:methods*; D012809:Colon, Sigmoid / Q000473:pathology; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000473:pathology; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009852:Omentum; D010388:Pelvis; D011446:Prospective Studies; D012007:Rectum / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*