The surgical management of radiation proctopathy

Abstract

Background: There is sparse evidence guiding the optimum surgical management of patients with radiation proctopathy (RP). The purpose of this review is to analyse all the literature on the surgical management of RP in order to guide physicians and surgeons as to when and what surgery should be employed for these patients.

Methods: A literature search of PubMed, EMBASE, MEDLINE, Ovid, and Cochrane Library using the MeSH terms "radiation proctopathy", "proctitis", "surgical management", and related terms as keywords was performed. The review included all articles that reported on the surgical management of patients with radiation proctopathy. All relevant articles were cross-referenced for further articles and any unavailable online were retrieved from hard-copy archive libraries. Eighteen studies including one prospective cohort study, fifteen retrospective cohort studies, and three small case series are included.

Conclusion: Surgery is indicated for patients with RP for rectal obstruction, perforation, fistulae, or a failure of medical measures to control the symptoms of RP. Surgery centres mainly on diversion version resection. Diversion alone does not remove the damaged tissue leaving the patient at risk of continued complications including bleeding, perforation, occlusion, and abscess formation; however, major resectional surgery carries higher risks. Morbidity and mortality vary 0-44% and 0-11% for diversion only versus 0-100% and 0-14% for resectional surgery. There is no universally agreed surgical first-line approach. The data supports both resection with defunctioning stoma or diversion only as reasonable first-line surgical options for patients requiring surgery for RP.

Keywords: Complications; Proctitis; Radiation proctopathy; Surgery; Surgical management.