Surgical treatment of complications of radiotherapy: Essentials in surgery
Necmi Kurt1, Hasan Ediz Sıkar1, Cemile Kurt2, Mehmet Eser1, Yıldıray Tuncer1, Kemal Eyvaz1, Selçuk Göktaş1, Fırat Tutal1
1Dr. Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi, 3. Genel Cerrahi Kliniği, İstanbul, Türkiye
2Dr. Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi, Aile Hekimliği, İstanbul, Türkiye
Purpose: Radiotherapy is frequently used following abdominopelvic surgical operations for malignancies. In this current study we tried to report our experience and methods for surgical repair of radiotherapy complications with review of literature.
Materials and Methods: Patients who have complications due to postoperative radiotherapy for abdominopelvic cancer (n=119) were retrospectively compared with 207 cases, who did not receive radiotherapy between 2005-2008. Patients were retrospectively evaluated according to the age, gender, primary disease, time of the occurrence of complications following the radiotherapy, accompanied disease, BMI, applied surgical methods, mortality and morbidity. Peritoneal carcinomatosis and complications related to other causes than radiation were excluded from the study.
Results : Fifty eight (48,7%) of patients who received radiotherapy did not require surgical repair, but 15 (12,6%) received surgical procedure. 5 (4.2%) of these patients died. In patients who did not received radiotherapy, number of complications which required surgical approach was only 3 (1.4%). There was a statistical significance between irradiated group and control group, according to gastrointestinal hemorrhage, ileus, fistula, proctitis, cystitis, enteritis and reoperation requirement (p<0,05; for fistula, proctitis, cystitis and p<0,001 for all other parameters ).
Conclusion: Number of complications are increasing in patients receiving radiotherapy following the surgery for abdominopelvic malignancies. Preoperative nutrition is very important in patients who require surgery for these complications. Preferred surgical method and technique is crucial in these cases. Diversion and bypass procedures should be considered.
Keywords: Radiotherapy, ileus, fistula, abdominopelvic tumor