Colostomy is a simple and effective procedure for severe chronic radiation proctitis

Yuan, Zixu; Ma, Tenghui; Wang, Huaiming; Zhong, Qinghua; Yu, Xihu; Qin, Qiyuan; Wang, Jianping; Wang, Lei

doi:10.3748/wjg.v22.i24.5598

Cited by 18 publications

(17 citation statements)

References 34 publications

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“…Colon tension or torsion should be avoided before the anastomosis. A transverse loop colostomy, which details were described in our previous study [ 20 ], was then created and a presacral drainage was placed. Stoma reversal was scheduled at least 6 months after the procedure, if no contraindication in rectal examination was found.…”

Section: Methodsmentioning

confidence: 99%

Restorative resection of radiation rectovaginal fistula can better relieve anorectal symptoms than colostomy only

Zhong

Yuan

et al. 2017

World J Surg Onc

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BackgroundRadiation-induced rectovaginal fistula (RVF) is a severe and difficult complication after pelvic malignancy radiation. This study was to retrospectively compare the outcomes of restorative resection and colostomy only in remission of anorectal symptoms.MethodsWe enrolled a cohort of 26 consecutive cases who developed RVF after pelvic radiation. Two main procedures for these patients in our institution were used: one was restorative resection and pull-through coloanal anastomosis with a prophylactic colostomy, and another was a simple colostomy without resection. Thus, we divided these patients into these two groups. Anorectal symptoms including rectal pain, bleeding, tenesmus, and perineal mucous discharge were recorded and scored prior to surgery and at postoperative multiple time points.ResultsThe baseline was similar among the two groups. All patients acquired good efficacy with improved symptoms at postoperative 6, 12, and 24 months, when compared to baseline. In addition, the resection group showed a better remission of tenesmus (6 months 33.3 vs 0%; 12 months 66.7 vs 16.7%) and perineal mucous discharge (6 months 88.9 vs 6.7%; 12 months 77.8 vs 15.4%; 24 months 85.7 vs 25.0%). Furthermore, three (30%) patients in the resection group successfully reversed stomas while no stoma was closed in the simple colostomy group.ConclusionsBoth restorative resection procedure and colostomy only can improve anorectal symptoms of radiation-induced RVF, but restorative resection can completely relieve anorectal symptoms in selected cases.

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Section: Methodsmentioning

confidence: 99%

Restorative resection of radiation rectovaginal fistula can better relieve anorectal symptoms than colostomy only

Zhong

Yuan

et al. 2017

World J Surg Onc

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“…For moderate to severe hemorrhagic CRP without massive ulcers which is refractory to medical management, modi ed formalin irrigation is an effective and safe method, with an effectiveness rate of 79.1% [42]. Further, if CRP patients suffer from severe intractable bleeding refractory to the above conservative treatments or require blood transfusions because of bleeding, diverting colostomy is a simple, effective and safe procedure, which obtained a higher rate of bleeding remission (94% vs. 12%) and obviously elevated hemoglobin levels, compared to conservative treatment [28]. Moreover, if hemorrhagic CRP patients couldn't manage after undergoing colostomy and conservative treatment or have stula or necrosis that with unbearable anal pain, resection of the severe damaged intestine and then colostomy could be a good choice.…”

Section: Discussionmentioning

confidence: 99%

“…The exclusion criteriawere:patients with acute radiation-induced enteritis (less than 3 months after radiotherapy, ARE); patients with previous blood related diseases or severe coagulation disorders; and patients with incomplete clinical data. [27,28] to assess the severity of bleeding.…”

Section: Patientsmentioning

confidence: 99%

Risk Prediction and Treatment of Hemorrhagic Chronic Radiation Intestinal Injury Patients With LE-DVT

Huang¹,

Kuang²,

Yuan³

et al. 2020

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Background: After pelvic malignancy radiation, chronic radiation intestinal injury (CRII) is an unavoidable complication, and bleeding is one of the most common symptoms of CRII. Lower extremity deep venous thrombosis (LE-DVT) is another severe complication.Once hemorrhagic CRII patients suffer from LE-DVT, hemostasis and anticoagulation therapy will be adopted simultaneously, which is a therapeutic paradox, extremely intractable and serious. This study was aimed to investigate prevalence and risk factors for LE-DVT in CRII patients, and explore treatment for hemorrhagic CRII patients with LE-DVTMethods: This is a retrospective study,a total of 608 CRII hospitalized patients from November 2011 to October 2018 after pelvic malignancy radiation in our hospital were included.Univariate and multivariate analysis were conducted to investigate the associated risk factors for LE-DVT in CRII patients. Receiver operating characteristic (ROC) curve analysis was performed to investigate the independent risk factors and determine their clinically valid cut-off points. Furthermore, treatment of hemorrhagic CRII patients with LE-DVT was explored.Results: Of the 608 included CRE patients, there were 94 (15.5%) CRII patients with suspicious symptoms of LE-DVT in the lower limbs, and 32 (5.3%) patients were diagnosed with LE-DVT. Among the CRII patients with LE-DVT, 65.6% (21/32) patients were with bleeding simultaneously, 29 (90.6%) patients were anemic, with 17 (53.1%) patients having moderate anemia and 7 (21.9%) having severe anemia. Multivariate analysis showed recent surgical history (≤6 Months) (OR=0.480, 95% CI: 1.430~9.377, p=0.007) and hemoglobin (Hb) (OR=0.965, 95% CI: 0.945~0.986, p=0.001) significantly associated with development of LE-DVT. ROC curve analysis showed optimal cut-off values of Hb were 82.5 g/L (AUC=0.756, 95% CI: 0.688~0.824, sensitivity=71.9%, specificity=75.5%). After colostomy, obvious bleeding remission was found in 84.6% of hemorrhagic CRII patients with LE-DVT rapidly. And LE-DVT of the patients was obvious improved or disappeared following anticoagulation therapy or with vena cava filter or stent placement.Conclusions: Prevalence of LE-DVT in hospitalized CRII patients was 5.3%. Recent surgical history and lower Hb were independently associated with LE-DVT developing in CRII patients. And colostomy could be a good choice for intractable hemorrhagic CRII patients with LE-DVT.

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“…Colostomy is preferred by some surgeons for radiation induced deep ulceration, fistula or stricture in intestine, which could prevent further deterioration of the complications and help to avoid further interventions [ 11 , 12 ]. Meanwhile, for CRP patients, colostomy is able to not only obviously control rectal bleeding, but also significantly relieve the pain, dramatically relieving the suffering of patients [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Diverting colostomy is an effective procedure for ulcerative chronic radiation proctitis patients after pelvic malignancy radiation

et al. 2020

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Background Chronic radiation proctitis (CRP) with rectal ulcer is a common complication after pelvic malignancy radiation, and gradually deteriorating ulcers will result in severe complications such as fistula. The aim of this study was to evaluate effect of colostomy on ulcerative CRP and to identify associated influence factors with effectiveness of colostomy. Methods Between November 2011 to February 2019, 811 hospitalized patients were diagnosed with radiation-induced enteritis (RE) in Sun Yat-sen University Sixth Affiliated Hospital, among which 284 patients presented with rectal ulcer, and 61 ulcerative CRP patients were retrospectively collected and analyzed. Results The overall effective rate of colostomy on ulcerative CRP was 49.2%, with a highest effective rate of 88.2% within 12 to 24 months after colostomy. 9 (31.1%) CRP patients with ulcers were cured after colostomy and 12 (19.67%) patients restored intestinal continuity, among which including 2 (3.3%) patients ever with rectovaginal fistula. 100% (55/55) patients with rectal bleeding and 91.4% (32/35) patients with anal pain were remarkably alleviated. Additionally, multivariable analysis showed the duration of stoma [OR 1.211, 95% CI (1.060–1.382), P = 0.005] and albumin (ALB) level post-colostomy [OR 1.437, 95% CI (1.102–1.875), P = 0.007] were two independent influence factors for the effectiveness of colostomy on the rectal ulcer of CRP patients. Conclusions Colostomy was an effective and safe procedure for treating rectal ulcer of CRP patients, and also a potential strategy for preventing and treating fistula. Duration of stoma for 12–24 months and higher ALB level could significantly improve the effectiveness of colostomy on ulcerative CRP patients.

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Colostomy is a simple and effective procedure for severe chronic radiation proctitis

Abstract: Diverting colostomy is a simple, effective and safe procedure for severe hemorrhagic CRP. Colostomy can improve quality of life and reduce serious complications secondary to radiotherapy.

Cited by 18 publications

References 34 publications

Restorative resection of radiation rectovaginal fistula can better relieve anorectal symptoms than colostomy only

Restorative resection of radiation rectovaginal fistula can better relieve anorectal symptoms than colostomy only

Risk Prediction and Treatment of Hemorrhagic Chronic Radiation Intestinal Injury Patients With LE-DVT

Diverting colostomy is an effective procedure for ulcerative chronic radiation proctitis patients after pelvic malignancy radiation

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