Surgical complications of oncological treatments: A narrative review

Abstract

Gastrointestinal complications are common in patients undergoing various forms of cancer treatments, including chemotherapy, radiation therapy, and molecular-targeted therapies. Surgical complications of oncologic therapies can occur in the upper gastrointestinal tract, small bowel, colon, and rectum. The mechanisms of action of these therapies are different. Chemotherapy includes cytotoxic drugs, which block the activity of cancer cells by targeting intracellular DNA, RNA, or proteins. Gastrointestinal symptoms are very common during chemotherapy, due to a direct effect on the intestinal mucosa resulting in edema, inflammation, ulceration, and stricture. Serious adverse events have been described as complications of molecular targeted therapies, including bowel perforation, bleeding, and pneumatosis intestinalis, which may require surgical evaluation. Radiotherapy is a local anti-cancer therapy, which uses ionizing radiation to cause inhibition of cell division and ultimately lead to cell death. Complications related to radiotherapy can be both acute and chronic. Ablative therapies, including radiofrequency, laser, microwave, cryoablation, and chemical ablation with acetic acid or ethanol, can cause thermal or chemical injuries to the nearby structures. Treatment of the different gastrointestinal complications should be tailored to the individual patient and based on the underlying pathophysiology of the complication. Furthermore, it is important to know the stage and prognosis of the disease, and a multidisciplinary approach is necessary to personalize the surgical treatment. The purpose of this narrative review is to describe complications related to different oncologic therapies that may require surgical interventions.

Chemotherapy-associated pneumoperitoneum in cancer patients: a scoping review

“…Several mechanisms have been postulated as the cause of gastrointestinal perforation secondary to chemotherapeutic agents. Antiangiogenic agents, in particular, reduce the capillary density of the mucosal layer and compromise intestinal wall integrity, thus increasing the risk of bowel ischaemia and subsequent perforation 48 , 49 . Other etiologies of bowel perforation include treatment response with tumour lysis or as sequelae of other side effects, most notably pneumatosis intestinalis and enterocolitis 48 .…”

“…Antiangiogenic agents, in particular, reduce the capillary density of the mucosal layer and compromise intestinal wall integrity, thus increasing the risk of bowel ischaemia and subsequent perforation 48 , 49 . Other etiologies of bowel perforation include treatment response with tumour lysis or as sequelae of other side effects, most notably pneumatosis intestinalis and enterocolitis 48 . Risk factors associated with bowel perforation and pneumoperitoneum subsequent to chemotherapeutic agent use include a primary gastrointestinal tumour, prior abdominal radiation, peptic ulcer disease, and peritoneal carcinomatosis 6 .…”

Entero-Cutaneous and Entero-Atmospheric Fistulas: Insights into Management Using Negative Pressure Wound Therapy

“…Bowel perforation is a rare but serious complication of chemotherapy [ 11 ]. Several mechanisms may be responsible for gastrointestinal perforation from oncologic treatments.…”

“…In addition, fistulas may result from erosion by suction catheters, adjacent abscesses or trauma. Contributing factors may include previous chemo-radiation therapy, intestinal obstruction, inflammatory bowel disease, mesenteric vascular disease, or intra-abdominal sepsis [ 8 , 9 , 10 , 11 ].…”