Absorbable mesh sling prevents radiation-induced bowel injury during "sandwich" chemoradiation for rectal cancer

Hypothesis: Absorbable mesh slings can prevent radiation-induced bowel inju ry when adjuvant pelvic radiotherapy is given in the early postoperative pe riod. We hypothesized that the mesh sling technique is similarly effective during "sandwich" sequence adjuvant chemoradiation. Design: Retrospective review. Setting: Tertiary care comprehensive cancer center. Patients: Nonrandomized series of 19 consecutive patients who underwent abd ominoperineal resection and received postoperative sandwich sequence chemor adiation at Roswell Park Cancer Institute, Buffalo, NY, between January 199 4 and September 1999. Interventions: Twelve patients had an absorbable mesh sling placed at the c ompletion of abdominoperineal resection. Seven patients did not have an abs orbable mesh sling placed. Main Outcome Measures: Radiotherapy dose and gastrointestinal toxic effects . Results: All 12 patients in the "mesh" group were able to receive full-dose radiotherapy with tumor bed boost (total dose, 54 Cy, Ii patients: 59.4 Gy , 1 patient). Only 3 of 7 patients in the "no mesh" group were able to rece ive a tumor bed boost (total dose, 46.8 Gy, 1 patient; 50.4 Gy, 3 patients, 54 Gy, 3 patients). Acute gastrointestinal toxic effects were minimal in t he mesh group (grade 1. 10 patients; grade 2, 2 patients) compared with the Ilo mesh group (grade 2, 6 patients: grade 3, 1 patients). None of the pat ients in the mesh group have shown evidence of late gastrointestinal toxic effects. One patient in the no mesh group required surgery for complication s of chronic radiation enteritis. Conclusions: The protective effects of an absorbable mesh sling extend beyo nd the life expectancy of the mesh itself. Sandwich sequence chemoradiation should not preclude the use of the mesh sling technique.