Published in:
01-03-2011 | Gynecologic Oncology
Radiation-Induced Bowel Complications: Laparoscopic Versus Open Staging of Gynecologic Malignancy
Authors:
Fabio Ghezzi, MD, Antonella Cromi, PhD, MD, Maurizio Serati, MD, Stefano Uccella, MD, Giorgio Formenti, MD, Giorgio Bogani, MD, Paolo Vanoli, MD
Published in:
Annals of Surgical Oncology
|
Issue 3/2011
Login to get access
Abstract
Purpose
To evaluate whether the type of surgical approach used to stage gynecologic malignancies influences the risk of developing nonrectal radiation-induced intestinal injury (NRRIII) in patients who subsequently receive adjuvant radiotherapy.
Methods
A prospectively entered database was queried for all women with either primary or recurrent gynecologic malignancy who underwent external-beam radiation therapy ± brachytherapy and who had prior abdominopelvic surgery at our institution. Univariate and multivariate analysis of variables potentially affecting the risk of developing significant bowel toxicity (defined as grade 2 or more according to Radiation Therapy Oncology Group scoring) were performed.
Results
One hundred fifty-nine patients were identified. The site of primary tumor was the cervix in 61 (38%) patients and the corpus uteri in the remaining patients (98, 62%). Treatment was delivered with a combination of external-beam and intracavitary irradiation to 50 (31.4%) patients, and 109 (68.6%) patients received only external-beam irradiation. Staging procedures were performed by open surgery in 93 (58.5%) patients, whereas laparoscopy was the surgical approach of choice in 66 (41.5%) women. Fifteen patients (9.4%) developed grade 2 or greater NRRIII, at median latency of 10 months (range 3–64 months); six were diagnosed as grade 3 complications requiring surgery, and three developed grade 4 complication. Multiple regression revealed an independent protective effect of pretreatment laparoscopic staging against the risk of developing both grade ≥2 and grade ≥3 NRRIII.
Conclusions
Notwithstanding potential limitations of nonrandomized study design, our findings suggest that the benefits of minimal-access surgery used to perform staging procedures may translate into long-term reduction in radiation-induced bowel injury.