Late radiation injuries of the small intestine--management and outcome

A series of 86 patients with late radiation-induced lesions, mainly stricture, of the small bowel is reviewed. The median interval from radiotherapy to manifestation of enteropathy was 2 (1/4 to 43) years. Progression of the lesions necessitated further treatment in 35 of the 70 patients who survived the initial attack. Bowel resection was followed by leakage from 12% of ileo-ileal and ileo-colic anastomoses. Mortality was 34% from the enteropathy and 8% from coexisting damage to the rectum or urinary tract. Factors significantly influencing mortality were pre-irradiation laparotomy, emergency surgery, and surgery to deal with a segment of irradiated intestine left in situ at initial operation. Age, stage of primary malignancy and coexisting rectal or urinary tract lesions did not significantly influence the outcome. After a median of 10 years' observation the outcome was classified as favourable in only 28% of cases, while 30% had slight to moderate symptoms or had died of unrelated causes. When surgery is required for radiation-related lesions of the small intestine, the aim should be a one-stage definitive procedure, as management of subsequently progressing lesions is associated with substantially increased mortality.