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Bowel disease after radiotherapy.

P F Schofield, D Holden, N D Carr

    Journal of the Royal Society of Medicine
    |June 1, 1983
    PubMed
    Summary
    This summary is machine-generated.

    Surgery can effectively treat bowel disease in patients who have undergone radiotherapy, addressing complications like ischemia, perforation, and obstruction. Early diagnosis and surgical intervention are crucial for favorable outcomes in these complex cases.

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    Area of Science:

    • Gastroenterology
    • Surgical Oncology
    • Radiation Oncology

    Background:

    • Radiotherapy for pelvic malignancies can lead to significant gastrointestinal complications.
    • Bowel disease following radiotherapy presents a spectrum of clinical manifestations.
    • Timely surgical intervention is often necessary for managing severe radiation-induced bowel damage.

    Purpose of the Study:

    • To present the clinical presentation, operative findings, and outcomes of patients requiring surgery for bowel disease post-radiotherapy.
    • To analyze the temporal relationship between radiotherapy and the development of surgical bowel complications.
    • To highlight the importance of surgical management for radiation-induced bowel disease.

    Main Methods:

    • Retrospective review of 40 patients who underwent surgery for bowel disease after radiotherapy.

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  • Analysis of clinical presentation, timing of onset post-radiotherapy, operative findings, and treatment outcomes.
  • Surgical techniques included wide resection of involved bowel, with proximal defunctioning stoma for anastomoses.

    • Main Results:

    • Presentations varied by time post-radiotherapy: acute ileitis within 1 month, radiation-induced local ischemia (perforation, bleeding, ulceration) most common between 3-18 months, and fibrous strictures/carcinoma later (2-24 years).
    • No operative mortality was observed.
    • Ten patients died subsequently, underscoring the long-term impact of these complications.

    Conclusions:

    • Bowel disease after radiotherapy, though infrequent, is often amenable to adequate surgical treatment.
    • It is crucial to avoid dismissing these patients as having incurable malignancy, as surgery can be effective.
    • Surgical management, including bowel resection and stoma protection, offers a viable treatment option for radiation-induced bowel complications.