Operative and long term results after surgery for chronic radiation enteritis

Background: About one third of patients with chronic radiation enteritis wi ll need to be operated on during follow-up. Morbidity and life expectancy a fter resection and conservative surgical management for chronic radiation e nteritis have not been well documented. Methods: From 1984 to 1994, 109 patients were operated on with a mean follo w-up of 40 months (range 1 to 293). Postoperative mortality, early and late morbidity, long-term survival were studied in patients after resection (n = 65) and after conservative surgical management (n = 42), and in patients after planned or emergency procedure. Existence of possible risk factors fo r reoperation after a first surgical procedure was analyzed. Results: Five (5%) patients died in the postoperative course. Operative mor tality was significantly higher when the procedure was performed as an emer gency (P <0.05). Although not statistically significant, mortality was high er in the resection group (5% versus 0%). Thirty-three (30%) patients exper ienced postoperative complications including anastomotic leak in 11. Morbid ity was not statistically related to the nature of the treatment (ie, conse rvative versus resection) or to the indication (emergency versus elective). During follow-up, reoperation was required in 40% of the patients, because of recurrence of digestive symptoms suggestive of chronic radiation enteri tis; the reoperation rate was higher in the patients of the conservative gr oup (50% versus 34%). Overall survival, after a mean follow-up of 40 months in patients without cancer recurrence was 85% at 1 year and 69% at 5 years after surgery, respectively. Overall survival was influenced by the nature of the treatment with 51% and 71% 5-year survival after conservative and r esection treatment, respectively. Conclusions: Despite high initial mortality and morbidity rates, life expec tancy in patients with chronic radiation enteritis without recurrence of th eir previous neoplastic disease was good. Resection seems to provide a smal ler reoperation rate and a better 5-year survival, but a higher postoperati ve mortality. (C) 2001 Excerpta Medica, Inc. An rights reserved.