A 25-year experience with postresection short-bowel syndrome secondary to radiation therapy.

BACKGROUND: Short-bowel syndrome (SBS) can be caused by abdominal and pelvic malignancies treated by radiation therapy (XRT). The management and long-term outcome of these patients is poorly defined. METHODS: This was a retrospective observational study. We reviewed 48 adults developing postresection SBS after XRT over a 25-year period. There were 36 women and 12 men ranging from 19 to 78 years. Follow-up evaluation ranged from 1 to 360 months. RESULTS: The underlying cancer in women included rectum (n = 13), ovary (n = 8), uterus (n = 7), and cervix (n = 6). In men, rectal cancer (n = 4) was most common. The interval to SBS was 1 to 234 months, with 16 (33%) patients developing SBS within 12 months. The indication for surgery was intestinal obstruction in 35, fistula in 9, perforation in 5, and ischemia in 2. Thirty-four (71%) patients underwent multiple resections and residual radiation enteritis was present in 34 (71%). Thirty-six (75%) patients also underwent colectomy and 28 (58%) had an ostomy. Intestinal remnant length was 60 cm or less in 11 patients, 60 to 120 cm in 16 patients, and 120 to 180 cm in 21 patients. Parenteral nutrition was weaned in 9 (19%) patients, and 30 (62%) patients remain on parenteral nutrition. Up to half (48%) of the patients had further intestinal procedures, including 2 liver-small-bowel transplants. Mortality during the follow-up period was 35%, with 8 patients dying within 12 months. CONCLUSIONS: Postresection SBS develops within months to years after XRT for mainly gynecologic and rectal malignancies. Intestinal obstruction is the most common reason for surgery. Multiple resections, colectomy, and ostomy are performed frequently. Long-term survival is possible in many patients although further surgical intervention, including transplantation, can be performed safely.

Duke Scholars

Author Debra L Sudan Surgery, Abdominal Transplant Surgery