title: Colostomy is a simple and effective procedure for severe chronic radiation proctitis.
abstract: OBJECTIVE
  To assess the efficacy and safety of diverting colostomy in treating severe hemorrhagic chronic radiation proctitis (CRP).
  
  
  METHODS
  Patients with severe hemorrhagic CRP who were admitted from 2008 to 2014 were enrolled into this study. All CRP patients were diagnosed by a combination of pelvic radiation history, clinical rectal bleeding, and endoscopic findings. Inclusion criteria were CRP patients with refractory bleeding with moderate to severe anemia with a hemoglobin level < 90 g/L. The study group included patients who were treated by diverting colostomy, while the control group included patients who received conservative treatment. The remission of bleeding was defined as complete cessation or only occasional bleeding that needed no further treatment. The primary outcome was bleeding remission at 6 mo after treatment. Quality of life before treatment and at follow-up was evaluated according to EORTC QLQ C30. Severe CRP complications were recorded during follow-up.
  
  
  RESULTS
  Forty-seven consecutive patients were enrolled, including 22 in the colostomy group and 27 in the conservative treatment group. When compared to conservative treatment, colostomy obtained a higher rate of bleeding remission (94% vs 12%), especially in control of transfusion-dependent bleeding (100% vs 0%), and offered a better control of refractory perianal pain (100% vs 0%), and a lower score of bleeding (P < 0.001) at 6 mo after treatment. At 1 year after treatment, colostomy achieved better remission of both moderate bleeding (100% vs 21.5%, P = 0.002) and severe bleeding (100% vs 0%, P < 0.001), obtained a lower score of bleeding (0.8 vs 2.0, P < 0.001), and achieved obvious elevated hemoglobin levels (P = 0.003), when compared to the conservative treatment group. The quality of life dramatically improved after colostomy, which included global health, function, and symptoms, but it was not improved in the control group. Pathological evaluation after colostomy found diffused chronic inflammation cells, and massive fibrosis collagen depositions under the rectal wall, which revealed potential fibrosis formation.
  
  
  CONCLUSIONS
  Diverting colostomy is a simple, effective and safe procedure for severe hemorrhagic CRP. Colostomy can improve quality of life and reduce serious complications secondary to radiotherapy.
authors.affiliation: Zi-Xu Yuan, Teng-Hui Ma, Huai-Ming Wang, Qing-Hua Zhong, Xi-Hu Yu, Qi-Yuan Qin, Jian-Ping Wang, Lei Wang, Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China.
authors.forename: Zi-Xu
authors.initials: ZX
authors.lastname: Yuan
authors.affiliation: Zi-Xu Yuan, Teng-Hui Ma, Huai-Ming Wang, Qing-Hua Zhong, Xi-Hu Yu, Qi-Yuan Qin, Jian-Ping Wang, Lei Wang, Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China.
authors.forename: Teng-Hui
authors.initials: TH
authors.lastname: Ma
authors.affiliation: Zi-Xu Yuan, Teng-Hui Ma, Huai-Ming Wang, Qing-Hua Zhong, Xi-Hu Yu, Qi-Yuan Qin, Jian-Ping Wang, Lei Wang, Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China.
authors.forename: Huai-Ming
authors.initials: HM
authors.lastname: Wang
authors.affiliation: Zi-Xu Yuan, Teng-Hui Ma, Huai-Ming Wang, Qing-Hua Zhong, Xi-Hu Yu, Qi-Yuan Qin, Jian-Ping Wang, Lei Wang, Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China.
authors.forename: Qing-Hua
authors.initials: QH
authors.lastname: Zhong
authors.affiliation: Zi-Xu Yuan, Teng-Hui Ma, Huai-Ming Wang, Qing-Hua Zhong, Xi-Hu Yu, Qi-Yuan Qin, Jian-Ping Wang, Lei Wang, Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China.
authors.forename: Xi-Hu
authors.initials: XH
authors.lastname: Yu
authors.affiliation: Zi-Xu Yuan, Teng-Hui Ma, Huai-Ming Wang, Qing-Hua Zhong, Xi-Hu Yu, Qi-Yuan Qin, Jian-Ping Wang, Lei Wang, Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China.
authors.forename: Qi-Yuan
authors.initials: QY
authors.lastname: Qin
authors.affiliation: Zi-Xu Yuan, Teng-Hui Ma, Huai-Ming Wang, Qing-Hua Zhong, Xi-Hu Yu, Qi-Yuan Qin, Jian-Ping Wang, Lei Wang, Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China.
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: Wang
authors.affiliation: Zi-Xu Yuan, Teng-Hui Ma, Huai-Ming Wang, Qing-Hua Zhong, Xi-Hu Yu, Qi-Yuan Qin, Jian-Ping Wang, Lei Wang, Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
mesh_terms: D016022:Case-Control Studies; D003125:Colostomy; D000072700:Conservative Treatment; D016889:Endometrial Neoplasms / Q000532:radiotherapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011349:Proctitis / Q000150:complications / Q000601:surgery*; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D011788:Quality of Life; D011832:Radiation Injuries / Q000150:complications / Q000601:surgery*; D012002:Rectal Diseases / Q000601:surgery; D012004:Rectal Neoplasms / Q000532:radiotherapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy
keywords: Chronic radiation proctitis; Diverting colostomy; Quality of life; Rectal bleeding; Serious complication