Influence of preoperative high-dose radiotherapy on postoperative outcome and colonic anastomotic healing

Ceelen, Wim; Malt, Mohamed El; Cardon, Anne; Berrevoet, Frederik; Neve, Wilfried De; Pattyn, Piet

doi:10.1007/bf02234573

Cited by 29 publications

(5 citation statements)

References 14 publications

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“…Firstly, the aim of proximally extended resection is to make sure that the proximal end of anastomosis is non-irradiated. Previous studies have revealed that avoiding the anastomosis of radiated bowel could reduce incidence of anastomotic leak and mortality and achieved good functional results ( 31 – 34 ). Galland et al reported that for use of non-irradiated bowel for at least one end of an anastomosis, the rate of anastomotic leak decreased from 51.8% (14/27) to 7.1% (1/14) and the mortality decreased from 37% (10/27) to 0 ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Proximally Extended Colorectal Resection With Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Late Complications of Chronic Radiation Proctopathy

Zhou

Huang

et al. 2022

Front. Surg.

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BackgroundChronic radiation proctopathy (CRP) is a common complication after radiation therapy for pelvic malignancies. Compared with diversion surgery, resection surgery removes the damaged tissue completely to avoid the risks of recurrence and improve patients' outcome. Hence, resection surgery could be an optimal surgical approach when CRP is complicated by late complications. This study aimed to describe a modified surgical procedure of resection surgery and report its preliminary efficacy and safety in treating patients with CRP with late complications.MethodsWe retrospectively reviewed the patients who were diagnosed with CRP with late complications and underwent the modified surgical procedure of laparoscopic proximally extended colorectal resection with two-Stage Turnbull-Cutait pull-through coloanal anastomosis (PE-Bacon) between November 2019 and October 2020 in the Sixth Affiliated Hospital of Sun Yat-sen University.ResultsA total of 15 patients were performed the modified laparoscopic procedure of PE-Bacon, of which 1 patient underwent conversion from laparoscopic to open operation for intraoperative massive hemorrhage. Overall, the major (Clavien-Dindo III-V) postoperative complications occurred in 1 patient, anastomotic leakage was observed in 2 (13.3%) patients, and anastomotic stricture was observed in 4 (26.7%) patients. No patient had to be reoperated and died. Up to now, at the average follow-up of (524.40 ± 108.39) days, the preoperative symptoms of 93.3% (14/15) patients were relieved, with nine patients achieved complete remission, five patients only suffered minor symptoms. Because of the progression of radiation uropathy, one patient still had a vesicovaginal fistula as pre-operative complication. Colostomy reversal has been performed on 8 (53.3%) patients at an average postoperative duration of 299.5 ± 92.68 days, among whom only 2 patients suffered from major Low Anterior Resection Syndrome (LARS) until now.ConclusionsLaparoscopic PE-Bacon surgery is a safe and feasible surgical procedure for late complications of CRP with low morbidity and high symptom remission rate.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Proximally Extended Colorectal Resection With Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Late Complications of Chronic Radiation Proctopathy

Zhou

Huang

et al. 2022

Front. Surg.

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“…Therefore, awareness of radiation damage should be raised for anterior resection after nCRT. Several animal studies have revealed that the anastomotic healing is impaired by radiation to both limbs of the bowel anastomosis [32–34]; however, the strength is not affected providing only one-sided limb is irradiated [35, 36]. Clinical evidence also shows that a safe anastomosis in the context of radiation enteritis should be constructed with non-irradiated bowel at least at one end [12, 13].…”

Section: Discussionmentioning

confidence: 99%

Radiation-induced injury on surgical margins: a clue to anastomotic leakage after rectal-cancer resection with neoadjuvant chemoradiotherapy?

Qin

Zhu

Wu³

et al. 2018

Gastroenterology Report

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Background Few studies on anastomotic condition after rectal-cancer resection and its effect on anastomotic leakage (AL) are available up to now. This study aimed to investigate potential radiation-induced injury left on surgical margins of anterior resection after neoadjuvant chemoradiotherapy (nCRT) and its association with AL. Methods We retrospectively identified 161 consecutive patients who underwent anterior resection with nCRT, neoadjuvant chemotherapy without radiation (nCT) or no neoadjuvant therapy between 2014 and 2015. Tissue samples of resection margins were assessed using a specific histopathological score and microvessel density in submucosa. Propensity score matching was used to balance the baseline characteristics. Association between AL and histopathological features was analysed. Results AL occurred in 13 of 54 patients undergoing nCRT, 5 of 48 patients undergoing nCT and 7 of 59 patients without neoadjuvant therapy. Comparisons after matching showed median (range) histopathological scores as follows: 3 (0–8) vs 0 (0–3) vs 0 (0–2) for the proximal margin ( P < 0.001); 4 (2–9) vs 0 (0–4) vs 0 (0–3) for the distal margin ( P < 0.001). Correspondingly, mean (SD) microvessel densities were as follows: 21.7 (7.9) vs 27.2 (8.6) vs 27.3 (9.4) for the proximal margin ( P = 0.003); 18.1 (9.3) vs 25.2 (12.9) vs 24.9 (7.4) for the distal margin ( P < 0.001). Among patients undergoing nCRT, AL was associated with increased histopathological score ( P = 0.003) and decreased microvessel density ( P = 0.004) on the proximal margin. Conclusions Surgical margins of rectal-cancer resection are exposed to certain radiation-induced injury after nCRT. AL is associated with aggravated radiation damage on the proximal margin.

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“…Preoperative radiotherapy is a significant consideration given its possible association with clinical anastomotic leaks [ 4 ]. When leveraging burst strength or collagen content as an indicator for anastomotic healing, preclinical models are conflicting regarding roles of preoperative radiotherapy, with some suggesting no difference in burst strength [ 115 , 120 ] or similar metrics [ 121 ] while others report a decrease in burst strength with radiotherapy [ 122 , 123 ]. Interestingly, while some suggest that radiotherapy alone is not sufficient to induce anastomotic leak, one study suggests that radiotherapy applied in more highly collagenolytic environments significantly predisposes to leak via enhanced MMP activation [ 121 ].…”

Section: Colorectal Mechanobiologymentioning

confidence: 99%

Mechanobiological considerations in colorectal stapling: Implications for technology development

Caulk

Chatterjee

Barr

et al. 2023

Surgery Open Science

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Influence of preoperative high-dose radiotherapy on postoperative outcome and colonic anastomotic healing

Abstract: In this rat model, preoperative high-dose radiotherapy using a clinically relevant fractionation scheme does not affect outcome or anastomotic healing when only one limb of the anastomosis is irradiated.

Cited by 29 publications

References 14 publications

Laparoscopic Proximally Extended Colorectal Resection With Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Late Complications of Chronic Radiation Proctopathy

Laparoscopic Proximally Extended Colorectal Resection With Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Late Complications of Chronic Radiation Proctopathy

Radiation-induced injury on surgical margins: a clue to anastomotic leakage after rectal-cancer resection with neoadjuvant chemoradiotherapy?

Mechanobiological considerations in colorectal stapling: Implications for technology development

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