Diverting Colostomy is an Effective Procedure for Ulcerative Chronic Radiation Proctitis Patients After Pelvic Malignancy Radiation

Abstract

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.