Diverting colostomy is an effective procedure for ulcerative chronic radiation proctitis patients after pelvic malignanc
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RESEARCH ARTICLE
Open Access
Diverting colostomy is an effective procedure for ulcerative chronic radiation proctitis patients after pelvic malignancy radiation Xiaoyan Huang1,2†, Qinghua Zhong3,4†, Huaiming Wang3†, Jie Zhao3, Yingyi Kuang3, Qi Guan3, Yanjiong He3, Qiyuan Qin3, Hui Wang3*† and Tenghui Ma3*†
Abstract Background: Chronic radiation proctitis (CRP) with rectal ulcer is a common complication after pelvic malignancy radiation, and gradually deteriorating ulcers will result in severe complications such as fistula. The aim of this study was to evaluate effect of colostomy on ulcerative CRP and to identify associated influence factors with effectiveness of colostomy. Methods: Between November 2011 to February 2019, 811 hospitalized patients were diagnosed with radiationinduced enteritis (RE) in Sun Yat-sen University Sixth Affiliated Hospital, among which 284 patients presented with rectal ulcer, and 61 ulcerative CRP patients were retrospectively collected and analyzed. Results: The overall effective rate of colostomy on ulcerative CRP was 49.2%, with a highest effective rate of 88.2% within 12 to 24 months after colostomy. 9 (31.1%) CRP patients with ulcers were cured after colostomy and 12 (19.67%) patients restored intestinal continuity, among which including 2 (3.3%) patients ever with rectovaginal fistula. 100% (55/55) patients with rectal bleeding and 91.4% (32/35) patients with anal pain were remarkably alleviated. Additionally, multivariable analysis showed the duration of stoma [OR 1.211, 95% CI (1.060–1.382), P = 0.005] and albumin (ALB) level post-colostomy [OR 1.437, 95% CI (1.102–1.875), P = 0.007] were two independent influence factors for the effectiveness of colostomy on the rectal ulcer of CRP patients. Conclusions: Colostomy was an effective and safe procedure for treating rectal ulcer of CRP patients, and also a potential strategy for preventing and treating fistula. Duration of stoma for 12–24 months and higher ALB level could significantly improve the effectiveness of colostomy on ulcerative CRP patients. Keywords: Chronic radiation proctitis, Rectal ulcer, Colostomy, Fistula, Influence factor
*Correspondence: [email protected]; [email protected] † Xiaoyan Huang, Qinghua Zhong and Huaiming Wang contributed equally as first authors. † Tenghui Ma and Hui Wang have contributed equally as corresponding authors. 3 Department of Colorectal Surgery, Sun Yat-Sen University Sixth Affiliated Hospital, No. 26 Yuancun Erheng Road, Guangzhou 510655, Guangdong, China Full list of author information is available at the end of the article
Background Radiotherapy is an essential therapeutic tool for pelvic malignancies such as uterine cervix, uterine corpus, prostate, testicular, urinary bladder and rectal cancers. Chronic radiation proctitis (CRP) is an unavoidable and commonly observed side effect, occurs 3 months later and in 5–20% of patients after pelvic malignancy radiation [1, 2]. While acute radiation proctitis (ARP) occurs
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