j o u r n a l o f s u r g i c a l r e s e a r c h 1 9 4 ( 2 0 1 5 ) 4 1 5 e4 1 9
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofSurgicalResearch.com
Laparoscopic surgery for radiation enteritis Jian Wang, MD, PhD, Danhua Yao, MD, PhD, Shaoyi Zhang, MD, Qi Mao, MD, PhD, Yousheng Li, MD, PhD,* and Jieshou Li, MD, PhD Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
article info
abstract
Article history:
Background: The aim of this study was to determine the safety and feasibility of laparo-
Received 29 August 2014
scopic surgery for radiation enteritis-induced intestinal stenosis requiring ileocecal
Received in revised form
resection.
30 October 2014
Methods: Clinical records of radiation enteritis patients that underwent laparoscopic ileo-
Accepted 14 November 2014
cecal resection and ileo-ascending colonic side-to-side anastomosis in a single center from
Available online 21 November 2014
January 2012eFebruary 2014 were retrospectively analyzed. Thirty patients were identified and matched by abdominal adhesion grade, age, gender, primary malignancy distribution,
Keywords:
previous abdominal surgery history, and body mass index to 30 patients that underwent
Laparoscopic surgery
open surgery for the same procedure from August 2009eDecember 2011. General infor-
Radiation enteritis
mation, operative findings, and short-term outcomes were compared between the two
Case-matched study
groups. Results: The conversion rate of laparoscopic surgery was 23.3%. The length of skin incision in the laparoscopic group was significantly shorter than that of the open surgery group (6.8 cm versus 15.8 cm, P ¼ 0.001). Laparoscopic surgery significantly decreased recovery time to total enteral nutrition (10.3 d versus 15.6 d, P ¼ 0.037); however, postoperative hospital stay was not significantly different between the two groups (28.2 d versus 32.4 d, P ¼ 0.924). Intraoperative blood loss (125 mL versus 189 mL, P ¼ 0.000) and operation time (138 min versus 171 min, P ¼ 0.003) were significantly improved in the laparoscopic group compared with those in the open surgery group. Laparoscopic surgery did not significantly decrease postoperative morbidity but did decrease the pleural effusion rate. Conclusions: Laparoscopic surgery is feasible for treatment of radiation enteritis-induced intestinal stenosis with a relatively low conversion rate. Laparoscopic surgery is as safe as open surgery and is superior to open surgery with decreased skin incision length, operation time, intraoperative blood loss, and postoperative recovery time to total enteral nutrition. ª 2015 Elsevier Inc. All rights reserved.
1.
Introduction
Radiation enteritis (RE) is an intestinal damage, represented by a spectrum of clinical manifestations, caused by abdominal or pelvic radiation. Surgical treatment is necessary for intestinal stenosis, intestinal perforation, and occasionally,
gastrointestinal hemorrhage [1]. Three to fifteen percent of RE patients will develop radiation enteritis-induced intestinal stenosis (REIIS) [2]. For REIIS, the surgical challenge lies in the dense intra-abdominal adhesion and fibrosis [3]. Postoperative complications including wound or anastomosis healing complications remain obstacles in traditional open
* Corresponding author. Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Road, Nanjing 210002, China. Tel.: þ86 25 8086 0137; fax: þ86 25 8541 9980. E-mail address: [email protected] (Y. Li). 0022-4804/$ e see front matter ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2014.11.026
416
j o u r n a l o f s u r g i c a l r e s e a r c h 1 9 4 ( 2 0 1 5 ) 4 1 5 e4 1 9
surgery [4]. The development of laparoscopic surgery has expanded the use of this technique from cholecystectomy to gastrointestinal cancer, and to other complicated inflammatory diseases such as Crohn disease [5] with the advantages of this technique simultaneously being identified. From 2012, the authors began to perform laparoscopic surgery for cases of RE. The aim of this study was to summarize the preliminary experience of laparoscopic surgery for REIIS and to determine the safety and feasibility of this technique.
2.
Materials and methods
2.1.
Patients
Laparoscopic surgery was introduced in our center on January 2012 by a team of surgeons. Clinical records of RE patients that presented with ileum stenosis and that underwent laparoscopic ileocecal resection and ileo-ascending colonic side-toside anastomosis from January 2012eFebruary 2014 were retrospectively reviewed. Patients that underwent open surgery for the same procedure in an earlier era, August 2009eDecember 2011 by the same unique team of surgeons, were 1:1 matched in terms of abdominal adhesion grade, age, gender, primary malignancy distribution, total radiation dose, interval between radiation and surgery, previous abdominal surgery history, and body mass index (BMI). All patients with REIIS in the two periods were considered for inclusion in this study. The exclusion criteria included emergent surgery, malignancy recurrence, preoperative short bowel syndrome (remnant small intestine
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofSurgicalResearch.com
Laparoscopic surgery for radiation enteritis Jian Wang, MD, PhD, Danhua Yao, MD, PhD, Shaoyi Zhang, MD, Qi Mao, MD, PhD, Yousheng Li, MD, PhD,* and Jieshou Li, MD, PhD Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
article info
abstract
Article history:
Background: The aim of this study was to determine the safety and feasibility of laparo-
Received 29 August 2014
scopic surgery for radiation enteritis-induced intestinal stenosis requiring ileocecal
Received in revised form
resection.
30 October 2014
Methods: Clinical records of radiation enteritis patients that underwent laparoscopic ileo-
Accepted 14 November 2014
cecal resection and ileo-ascending colonic side-to-side anastomosis in a single center from
Available online 21 November 2014
January 2012eFebruary 2014 were retrospectively analyzed. Thirty patients were identified and matched by abdominal adhesion grade, age, gender, primary malignancy distribution,
Keywords:
previous abdominal surgery history, and body mass index to 30 patients that underwent
Laparoscopic surgery
open surgery for the same procedure from August 2009eDecember 2011. General infor-
Radiation enteritis
mation, operative findings, and short-term outcomes were compared between the two
Case-matched study
groups. Results: The conversion rate of laparoscopic surgery was 23.3%. The length of skin incision in the laparoscopic group was significantly shorter than that of the open surgery group (6.8 cm versus 15.8 cm, P ¼ 0.001). Laparoscopic surgery significantly decreased recovery time to total enteral nutrition (10.3 d versus 15.6 d, P ¼ 0.037); however, postoperative hospital stay was not significantly different between the two groups (28.2 d versus 32.4 d, P ¼ 0.924). Intraoperative blood loss (125 mL versus 189 mL, P ¼ 0.000) and operation time (138 min versus 171 min, P ¼ 0.003) were significantly improved in the laparoscopic group compared with those in the open surgery group. Laparoscopic surgery did not significantly decrease postoperative morbidity but did decrease the pleural effusion rate. Conclusions: Laparoscopic surgery is feasible for treatment of radiation enteritis-induced intestinal stenosis with a relatively low conversion rate. Laparoscopic surgery is as safe as open surgery and is superior to open surgery with decreased skin incision length, operation time, intraoperative blood loss, and postoperative recovery time to total enteral nutrition. ª 2015 Elsevier Inc. All rights reserved.
1.
Introduction
Radiation enteritis (RE) is an intestinal damage, represented by a spectrum of clinical manifestations, caused by abdominal or pelvic radiation. Surgical treatment is necessary for intestinal stenosis, intestinal perforation, and occasionally,
gastrointestinal hemorrhage [1]. Three to fifteen percent of RE patients will develop radiation enteritis-induced intestinal stenosis (REIIS) [2]. For REIIS, the surgical challenge lies in the dense intra-abdominal adhesion and fibrosis [3]. Postoperative complications including wound or anastomosis healing complications remain obstacles in traditional open
* Corresponding author. Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Road, Nanjing 210002, China. Tel.: þ86 25 8086 0137; fax: þ86 25 8541 9980. E-mail address: [email protected] (Y. Li). 0022-4804/$ e see front matter ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2014.11.026
416
j o u r n a l o f s u r g i c a l r e s e a r c h 1 9 4 ( 2 0 1 5 ) 4 1 5 e4 1 9
surgery [4]. The development of laparoscopic surgery has expanded the use of this technique from cholecystectomy to gastrointestinal cancer, and to other complicated inflammatory diseases such as Crohn disease [5] with the advantages of this technique simultaneously being identified. From 2012, the authors began to perform laparoscopic surgery for cases of RE. The aim of this study was to summarize the preliminary experience of laparoscopic surgery for REIIS and to determine the safety and feasibility of this technique.
2.
Materials and methods
2.1.
Patients
Laparoscopic surgery was introduced in our center on January 2012 by a team of surgeons. Clinical records of RE patients that presented with ileum stenosis and that underwent laparoscopic ileocecal resection and ileo-ascending colonic side-toside anastomosis from January 2012eFebruary 2014 were retrospectively reviewed. Patients that underwent open surgery for the same procedure in an earlier era, August 2009eDecember 2011 by the same unique team of surgeons, were 1:1 matched in terms of abdominal adhesion grade, age, gender, primary malignancy distribution, total radiation dose, interval between radiation and surgery, previous abdominal surgery history, and body mass index (BMI). All patients with REIIS in the two periods were considered for inclusion in this study. The exclusion criteria included emergent surgery, malignancy recurrence, preoperative short bowel syndrome (remnant small intestine
