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Report of 34 Cases With a High Share of Patients With Combined Chemotherapy

Johannes Miholic, MD; Otto Schlappack, MD; Walter Klepetko, MD; Heinz Kölbl, MD; Tibor Szepesi, MD; Peter Moeschl, MD

Arch Surg. 1987;122(8):923-926.

Abstract
• Operations on irradiation-injured bowel are rare, bear a high postoperative mortality, and the procedure of choice (resection vs bypass) is still controversial. Thirty-seven operations on small bowel for late effects of irradiation in 16 years were analyzed retrospectively. Fifty-one percent of the operations were performed in the last four years. Ovarian cancer treated by a combination of radiotherapy and chemotherapy was the most frequent underlying disease of 20 patients (58%) followed by carcinoma of the cervix (eight [24%] of the patients). The median latent period between irradiation and surgery was eight months after the combined radiotherapy/chemotherapy, and 12 months after radiotherapy alone. Thirty operations (81%) were done for small-bowel stricture, four for fistula, and three for perforation. Bypass was performed in 17 patients and resection in 16. Complications (fistula, peritonitis, perforation) occurred after 13 operations (35%). All three patients who developed peritonitis died (mortality, 8.1%): two after resection and one after bypass. Suture-associated complications occurred in three (23%) of 13 cases after single-layer and in three (35%) of 17 cases after two-layer anastomoses. Ten patients are still alive two to 76 months (median, 32 months) after operation, six of them free of tumor. All are underweight and suffer from diarrhea (four to 12 stools per day). Pernicious anemia developed in all six patients surviving more than two years.

(Arch Surg 1987;122:923-926)

Author Affiliations
From the II Chirurgische Universitätsklinik (Drs Miholic, Klepetko, and Moeschl), Klinik für Strahlentherapie (Drs Schlappack and Szepesi), and II Universitäts-Frauenklinik (Dr Kölbl), University of Vienna.

Footnotes
Accepted for publication July 18, 1986.

Reprint requests to II Chirurgische Universitätsklinik, Allgemeines Krankenhaus, Spitalgasse 23, A-1090 Vienna, Austria (Dr Miholic).

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