[Rectal perforation : A rare complication following radiotherapy]

Area of Science:

• Oncology
• Gastroenterology
• Surgical Oncology

Background:

• Radiotherapy is a standard treatment for prostate cancer.
• Intestinal complications can be acute or chronic, with chronic issues like rectal perforation and fistula formation being rare and challenging.
• Existing evidence for managing chronic radiotherapy complications is limited.

Purpose of the Study:

• To provide an overview of surgical therapy strategies for chronic radiotherapy complications, specifically rectal fistula formation.
• To consolidate current knowledge on managing rare but severe post-radiotherapy intestinal issues.

Main Methods:

• Literature review of surgical treatment options for chronic radiotherapy complications.
• Analysis of established and preferred surgical techniques for rectal perforation and fistula.

Main Results:

• Established algorithms exist for acute intestinal toxicity management.
• Acute rectal perforation treatment includes suture repair or resection, with or without diversion/restoration.
• Chronic rectal lesions and fistulas benefit from abdominal strategies, often involving omental or vascularized muscle flaps.

Conclusions:

• Surgical treatment for rare chronic rectourethral and rectovesical fistulas presents a significant interdisciplinary challenge.
• Management of these complex fistulas requires specialized centers and a multidisciplinary approach.