title: Postoperative complications following intraoperative radiotherapy in abdominopelvic malignancy: A single institution analysis of 113 consecutive patients.
abstract: BACKGROUND
  Intraoperative radiotherapy (IORT) has advantages over external beam radiation therapy (EBRT). Few studies have described side effects associated with its addition. We evaluated our institution's experience with abdominopelvic IORT to assess safety by postoperative complication rates.
  
  
  METHODS
  Prospectively collected IRB-approved database of all patients receiving abdominopelvic IORT (via high dose rate brachytherapy) at Johns Hopkins Hospital between November 2006 and May 2014 was reviewed. Patients were discussed in multidisciplinary conferences. Those selected for IORT were patients for whom curative intent resection was planned for which IORT could improve margin-negative resection and optimize locoregional control. Perioperative complications were classified via Clavien-Dindo scale for postoperative surgical complications.
  
  
  RESULTS
  A total of 113 patients were evaluated. Most common diagnosis was sarcoma (50/113, 44%) followed by colorectal cancer (45/113, 40%), most of which were recurrent (84%). There were no perioperative deaths. A total of 57% of patients experienced a complication Grade II or higher: 24% (27/113) Grade II; 27% (30/113) Grade III; 7% (8/113) Grade IV. Wound complications were most common (38%), then gastrointestinal (25%). No radiotherapy variables were significantly associated with complications on uni/multi-variate analysis.
  
  
  CONCLUSIONS
  Our institution's experience with IORT demonstrated historically expected postoperative complication rates. IORT is safe, with acceptable perioperative morbidity.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Eihab
authors.identifier: http://orcid.org/0000-0002-5503-8685
authors.initials: E
authors.lastname: Abdelfatah
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Andrew
authors.initials: A
authors.lastname: Page
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Justin
authors.initials: J
authors.lastname: Sacks
authors.affiliation: Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Phillip
authors.initials: P
authors.lastname: Pierorazio
authors.affiliation: Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Trinity
authors.initials: T
authors.lastname: Bivalacqua
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Efron
authors.affiliation: Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Terezakis
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Susan
authors.initials: S
authors.lastname: Gearhart
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Sandy
authors.initials: S
authors.lastname: Fang
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Bashar
authors.initials: B
authors.lastname: Safar
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.affiliation: Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Elwood
authors.initials: E
authors.lastname: Armour
authors.affiliation: Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Amy
authors.initials: A
authors.lastname: Hacker-Prietz
authors.affiliation: Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Joseph
authors.initials: J
authors.lastname: Herman
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.|Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.|Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Nita
authors.initials: N
authors.lastname: Ahuja
mesh_terms: D000008:Abdominal Neoplasms / Q000473:pathology / Q000628:therapy*; D001918:Brachytherapy; D015179:Colorectal Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D010386:Pelvic Neoplasms / Q000473:pathology / Q000628:therapy*; D011183:Postoperative Complications / Q000145:classification; D018714:Radiotherapy, Adjuvant; D012186:Retroperitoneal Neoplasms / Q000473:pathology / Q000628:therapy*; D012509:Sarcoma / Q000473:pathology / Q000628:therapy*
keywords: colorectal cancer; high dose rate brachytherapy; radiation therapy; rectal cancer; sarcoma