This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on ISI (1)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Radiation Therapy  • Alert me on articles by topic

Brad E. Waddell, MD; R. Jeffery Lee, MD; Miguel A. Rodriguez-Bigas, MD; Thomas K. Weber, MD; Nicholas J. Petrelli, MD

Arch Surg. 2000;135:1212-1217.

Hypothesis  Absorbable mesh slings can prevent radiation-induced bowel injury when adjuvant pelvic radiotherapy is given in the early postoperative period. We hypothesized that the mesh sling technique is similarly effective during "sandwich" sequence adjuvant chemoradiation.

Design  Retrospective review.

Setting  Tertiary care comprehensive cancer center.

Patients  Nonrandomized series of 19 consecutive patients who underwent abdominoperineal resection and received postoperative sandwich sequence chemoradiation at Roswell Park Cancer Institute, Buffalo, NY, between January 1994 and September 1999.

Interventions  Twelve patients had an absorbable mesh sling placed at the completion of abdominoperineal resection. Seven patients did not have an absorbable mesh sling placed.

Main Outcome Measures  Radiotherapy dose and gastrointestinal toxic effects.

Results  All 12 patients in the "mesh" group were able to receive full-dose radiotherapy with tumor bed boost (total dose, 54 Gy, 11 patients; 59.4 Gy, 1 patient). Only 3 of 7 patients in the "no mesh" group were able to receive a tumor bed boost (total dose, 46.8 Gy, 1 patient; 50.4 Gy, 3 patients; 54 Gy, 3 patients). Acute gastrointestinal toxic effects were minimal in the mesh group (grade 1, 10 patients; grade 2, 2 patients) compared with the no mesh group (grade 2, 6 patients; grade 3, 1 patients). None of the patients in the mesh group have shown evidence of late gastrointestinal toxic effects. One patient in the no mesh group required surgery for complications of chronic radiation enteritis.

Conclusions  The protective effects of an absorbable mesh sling extend beyond the life expectancy of the mesh itself. Sandwich sequence chemoradiation should not preclude the use of the mesh sling technique.

From the Divisions of Surgical Oncology (Drs Waddell, Rodriguez-Bigas, Weber, and Petrelli) and Radiation Oncology (Dr Lee), Roswell Park Cancer Institute, State University of New York at Buffalo.

RELATED ARTICLE

Archives of Surgery Reader's Choice: Continuing Medical Education
Arch Surg. 2000;135(10):1234.
FULL TEXT