Operative and long term results after diseased bowel resection for chronic radiation enteritis complicated with intestinal obstruction / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To report operative and long-term results after surgery for chronic radiation enteritis and to evaluate the therapeutic efficacy of surgery and investigate the risk factors of postoperative survival rate.</p><p><b>METHODS</b>The 120 CRE patients performed with diseased bowel resection from June 2001 to March 2011 were analyzed retrospectively and followed up by telephone. There were 22 male and 98 female patients and their age were 23-82 years (median 52 years). Their demographic data, the cancer history, the characteristics of radiotherapy received (total dose, defined as the cumulative dose of external and endocavity radiation), the time interval between the first symptoms and the first surgical procedure, postoperative complications, length of residual small bowel, postoperative survival rate were recorded. Evaluate the therapeutic efficacy of surgery and investigate the risk factors of postoperative survival rate.</p><p><b>RESULTS</b>The postoperative overall complications and the incidence of moderate to severe complications (Clavien-Dindo Grade III-V) were 61.7% and 33.3%, respectively. The postopertive mortality was 2.5%. The survival probabilities were 96%, 60% and 37% at 1-, 5- and 10-years, respectively. At the end of follow up, the mean of body mass index (BMI) increased compared with the BMI of preoperatiive ((17.6 ± 3.0) kg/m(2) vs. (20.2 ± 3.0) kg/m(2), t = 6.01, P < 0.01). The 93% of patients can stop PN and regain full oral diet after operation (χ(2) = 164.1, P < 0.01). On multivariate analysis, survival was significantly decreased with residual neoplastic disease (HR = 4.082, 95%CI 1.318-12.648), an American Society of Anesthesiologists score>3 (HR = 3.495, 95%CI 1.131-10.800) and an age of chronic radiation enteritis diagnosis >70 years (HR = 2.800, 95%CI 0.853-9.189).</p><p><b>CONCLUSIONS</b>The survival of patients with chronic radiation enteritis complicated with intestinal obstruction after intestinal resection was good and was mainly influenced by underlying comorbidities. Majority of the patients can stop PN and regain full oral diet after operation.</p>