Surgical Management of Small-Bowel Radiation Enteritis

Lillemoe, Keith D.; Brigham, Robert A.; Harmon, John W.; Feaster, Marshall M.; Saunders, John R.; d'Avis, Juan A.

doi:10.1001/archsurg.1983.01390080013004

Cited by 35 publications

(11 citation statements)

References 7 publications

(3 reference statements)

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“…Long-term radiation injury to the gastrointestinal tract is a common complication of irradiation for pelvic and abdominal tumors. 4,10 Less commonly reported symptoms include severe lesions to the upper digestive tract in patients receiving radiotherapy for head and neck malignancies. Obviously, there is a large interindividual variability in the long-term outcome of radiotherapy to normal tissue in the upper esophagus.…”

Section: Discussionmentioning

confidence: 99%

Stricture of the proximal esophagus in head and neck carcinoma patients after radiotherapy

Laurell

Kraepelien

Mavroidis

et al. 2003

Cancer

138

126

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BACKGROUNDIt is well recognized that many patients with head and neck carcinoma have problems with food intake and malnutrition. The objective of the current study was to determine the clinical pattern of patients with nonneoplastic stricture of the upper esophagus after radiotherapy for head and neck carcinoma.METHODSA retrospective chart study of 22 patients with stricture of the proximal esophagus diagnosed between 1993 and 1999 at Karolinska Hospital was performed. The dose volume histograms of the first 2 cm and 5 cm, respectively, of the proximal esophagus were calculated.RESULTSFive of the patients (23%) had total obliteration. The first 2 cm of the esophagus received at least 60 grays (Gy) in > 80% of the volume. Radiation injury was not reported to occur at doses < 60 Gy. There was a correlation found between dysphagia during radiotherapy and the development of proximal esophageal stricture. Stricture was diagnosed 1–60 months (median, 6 months) after radiotherapy. In 18 patients, the stricture was treated with single or repeated endoscopic dilation. These treatments allowed a nearly normal diet in 78% of the patients.CONCLUSIONSStricture of the upper esophagus is one deglutition disorder that is reported to occur after radiotherapy for head and neck carcinoma. In the current study, the authors emphasize the importance of knowing the tolerance of the normal esophagus to irradiation as well as early diagnosis of stricture of the proximal esophagus because this condition may lead to physical and emotional distress. Cancer 2003;97:1693–700. © 2003 American Cancer Society.DOI 10.1002/cncr.11236

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Section: Discussionmentioning

confidence: 99%

Stricture of the proximal esophagus in head and neck carcinoma patients after radiotherapy

Laurell

Kraepelien

Mavroidis

et al. 2003

Cancer

138

126

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“…615 of 1,036 patients (59.4%) presented a history of laparotomy prior to radiotherapy [1, 2, 4, 5, 6, 7, 8, 10, 11, 12, 15, 17, 18, 23, 24, 25, 26, 27, 28, 31, 32, 33, 34, 37, 39, 41]. Operations prior to radiation have been discussed to trigger radiogenic injury.…”

Section: Pathology History Clinical Presentationmentioning

confidence: 99%

“…The clinical diagnosis of radiogenic bowel disease in every day practice is impaired by latency periods between radiotherapy and symptomatic small bowel injury ranging from 1 month to 44 years (mean 3.4 ± 3.8 years) [1, 2, 4, 5, 6, 7, 8, 10, 11, 13, 17, 18, 19, 20, 22, 23, 24, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 39]. The patient age at presentation with radiation injury necessitating operation ranged from 53 to 66 (mean 56.6 ± 4.0) years [1, 5, 6, 7, 8, 9, 10, 23, 26, 27, 28, 29, 30, 32, 34, 35, 37, 39, 41].…”

Section: Pathology History Clinical Presentationmentioning

confidence: 99%

“…The patient age at presentation with radiation injury necessitating operation ranged from 53 to 66 (mean 56.6 ± 4.0) years [1, 5, 6, 7, 8, 9, 10, 23, 26, 27, 28, 29, 30, 32, 34, 35, 37, 39, 41]. Of 1,316 patients with small bowel injury, 296 (22.5%) had associated colorectal injuries [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42], a factor influencing diagnosis and tactics. Radiation injuries are distributed disproportionally over the intestinal tract: lower ileum, cecum and sigmoid are the dominating segments, whereas jejunum, midgut and transverse colon are very rarely affected (table 1), an important aspect in decision-making.…”

Section: Pathology History Clinical Presentationmentioning

confidence: 99%

“…The study periods forming the basis of this analysis range from 1 to 50 (mean 15.5 ± 9.9) years. Figure 1 shows their pertinent duration and historical distribution [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41]. …”

Section: Introductionmentioning

confidence: 99%

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Late Radiogenic Small Bowel Damage: Guidelines for the General Surgeon

Meissner

1999

Dig Surg

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Background/Aims: The majority of late radiogenic small bowel injuries presents with obstruction or peritonitis. Owing to an average latency period of years, many of these patients are admitted to community hospitals and treated by general surgeons, who in turn see only a few pertinent patients in their professional lifetime. This study intends to provide the general surgeon with comprehensive guidelines for safer surgical management. Material and Methods: Forty-one publications were analyzed in a search for clinical, procedural and outcome data. Results: After a mean interval of 3.4 years following radiotherapy, patients with a mean age of 57 years present with obstruction (71%), fistula (17%), perforation (10%) or hemorrhage (2%) due to small bowel radiation injury. 22% have associated colorectal injury. The intestinal compartments most frequently affected are lower ileum, cecum and rectosigmoid, whereas the midgut and transverse colon are usually free. Consequently, the dehiscence rate of resection and ileoileostomy is 26%, jejunoileostomy 12%, ileoascendostomy 9% and ileotransversostomy 4%, and the pertinent rate of progressive radiation injury is 9.1%. Bypass procedures yield an overall dehiscence rate of 9%, ileotransverse bypass 1.6%, and the rate of progressive radiation injury is 37%. The lethality of suture line insufficiency is 85%. Lysis carries a lethal perforation rate of 6%. Only 58% of patients survive over 2 years, and of those not succumbing to unrelated disease, 37% die from progressive radiation injury and 63% from tumor progression. Conclusion: If resection is warranted, a reasonably extended ileal resection, right hemicolectomy and ileotransversostomy, is safe. Likewise, ileotransverse anastomosis is the best choice for bypass. Lysis should not be inforced in radiation-injured bowel compartments. Terminal enterostomy with distal mucous fistula alleviates otherwise untreatable fistulae.

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Polymorphisms in the interferon‐γ/interleukin‐26 gene region contribute to sex bias in susceptibility to rheumatoid arthritis

Vandenbroeck¹,

Cunningham²,

Goris³

et al. 2003

Arthritis & Rheumatism

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Objective. To determine whether polymorphisms in the interferon-␥ (IFN␥)/interleukin-26 (IL-26; formerly, AK155) gene cluster contribute to sex-based differential susceptibility to rheumatoid arthritis (RA).Methods. Four microsatellite markers, located in a 118-kb interval that contains both the IFN␥ and IL-26 genes on chromosome 12q15, were typed in 251 patients with RA and 198 unrelated healthy controls (all of whom lived in Northern Ireland) by means of polymerase chain reaction-based fragment analysis.Results. Marker D12S2510, which is located 3 kb 3 from the IL-26 gene, was significantly associated with RA in women (corrected P [P corr ] ‫؍‬ 0.008, 2 degrees of freedom [2 df]) but not in men (P ‫؍‬ 0.99, 2 df). A 3-marker haplotype, IFNGCA*13;D12S2510*8; D12S2511*9, was inferred that showed significant underrepresentation in women with RA (odds ratio 0.50, 95% confidence interval 0.32-0.78; P ‫؍‬ 0.002, P corr ‫؍‬ 0.03) but not in men with RA.Conclusion. Our results demonstrate that common polymorphisms in the IFN␥/IL-26 gene region may contribute to sex bias in susceptibility to RA, by distorting the propensity of female carriers versus male carriers to contract this disease. These results conform to our recent observations of a role for this gene cluster in sex-based differential susceptibility to another Th1-type inflammatory disease, multiple sclerosis.

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Surgical Management of Small-Bowel Radiation Enteritis

Cited by 35 publications

References 7 publications

Stricture of the proximal esophagus in head and neck carcinoma patients after radiotherapy

Stricture of the proximal esophagus in head and neck carcinoma patients after radiotherapy

Late Radiogenic Small Bowel Damage: Guidelines for the General Surgeon

Polymorphisms in the interferon‐γ/interleukin‐26 gene region contribute to sex bias in susceptibility to rheumatoid arthritis

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