Does external beam radiation therapy to the pelvis portend worse ileal pouch outcomes? An international multi-institution collaborative study

Amy Lightner, A. Spinelli, N. P. McKenna, Christopher Hallemeier, P. Fleshner

Research output: Contribution to journalArticle

Abstract

Aim: Short-term morbidity and long-term functional outcome of patients with an ileal pouch-anal anastomosis (IPAA) exposed to pelvic external beam radiation therapy (EBRT) remains unknown. We report the largest series to date regarding the effects of pelvic EBRT on: (i) 30-day postoperative outcomes; and (ii) long-term functional outcome following IPAA. Method: A retrospective chart review was conducted of patients who received EBRT before or after IPAA between 1980 and 2017 across three international inflammatory bowel disease referral centres. Results: Nineteen patients were included. Indications for EBRT were rectal adenocarcinoma (n = 13), prostate adenocarcinoma (n = 4) or anal squamous cell carcinoma (ASCC) (n = 2). EBRT was given prior to IPAA in 12 (63%) patients and after IPAA in seven (37%). In EBRT before IPAA, patients had a median of 5 (range: 4–8) daytime bowel movements, 1 (range: 0–5) night-time bowel movement, no daytime incontinence, and only one patient used pads at a median follow up of 25 (range: 11–163) months; one patient underwent pouch excision 15 months after IPAA. In EBRT after IPAA, patients reported a median of 8 (range: 5–10) daytime and 2 (range: 0–5) night-time bowel movements, 80% had either daytime or night-time incontinence and 80% used pads at a median follow up of 90 (range: 25–315) months. Conclusion: Pelvic EBRT administered prior to IPAA is associated with acceptable long-term function outcome. However, when pelvic EBRT is given to an IPAA in situ, most patients experience poor long-term pouch function without pouch failure.

Original languageEnglish (US)
JournalColorectal Disease
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Colonic Pouches
Pelvis
Radiotherapy
Adenocarcinoma
Inflammatory Bowel Diseases
Prostate
Squamous Cell Carcinoma
Referral and Consultation
Morbidity

Keywords

  • IPAA
  • pouch function
  • radiation to pouch

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Does external beam radiation therapy to the pelvis portend worse ileal pouch outcomes? An international multi-institution collaborative study. / Lightner, Amy; Spinelli, A.; McKenna, N. P.; Hallemeier, Christopher; Fleshner, P.

In: Colorectal Disease, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Aim: Short-term morbidity and long-term functional outcome of patients with an ileal pouch-anal anastomosis (IPAA) exposed to pelvic external beam radiation therapy (EBRT) remains unknown. We report the largest series to date regarding the effects of pelvic EBRT on: (i) 30-day postoperative outcomes; and (ii) long-term functional outcome following IPAA. Method: A retrospective chart review was conducted of patients who received EBRT before or after IPAA between 1980 and 2017 across three international inflammatory bowel disease referral centres. Results: Nineteen patients were included. Indications for EBRT were rectal adenocarcinoma (n = 13), prostate adenocarcinoma (n = 4) or anal squamous cell carcinoma (ASCC) (n = 2). EBRT was given prior to IPAA in 12 (63{\%}) patients and after IPAA in seven (37{\%}). In EBRT before IPAA, patients had a median of 5 (range: 4–8) daytime bowel movements, 1 (range: 0–5) night-time bowel movement, no daytime incontinence, and only one patient used pads at a median follow up of 25 (range: 11–163) months; one patient underwent pouch excision 15 months after IPAA. In EBRT after IPAA, patients reported a median of 8 (range: 5–10) daytime and 2 (range: 0–5) night-time bowel movements, 80{\%} had either daytime or night-time incontinence and 80{\%} used pads at a median follow up of 90 (range: 25–315) months. Conclusion: Pelvic EBRT administered prior to IPAA is associated with acceptable long-term function outcome. However, when pelvic EBRT is given to an IPAA in situ, most patients experience poor long-term pouch function without pouch failure.",
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AU - Hallemeier, Christopher

AU - Fleshner, P.

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N2 - Aim: Short-term morbidity and long-term functional outcome of patients with an ileal pouch-anal anastomosis (IPAA) exposed to pelvic external beam radiation therapy (EBRT) remains unknown. We report the largest series to date regarding the effects of pelvic EBRT on: (i) 30-day postoperative outcomes; and (ii) long-term functional outcome following IPAA. Method: A retrospective chart review was conducted of patients who received EBRT before or after IPAA between 1980 and 2017 across three international inflammatory bowel disease referral centres. Results: Nineteen patients were included. Indications for EBRT were rectal adenocarcinoma (n = 13), prostate adenocarcinoma (n = 4) or anal squamous cell carcinoma (ASCC) (n = 2). EBRT was given prior to IPAA in 12 (63%) patients and after IPAA in seven (37%). In EBRT before IPAA, patients had a median of 5 (range: 4–8) daytime bowel movements, 1 (range: 0–5) night-time bowel movement, no daytime incontinence, and only one patient used pads at a median follow up of 25 (range: 11–163) months; one patient underwent pouch excision 15 months after IPAA. In EBRT after IPAA, patients reported a median of 8 (range: 5–10) daytime and 2 (range: 0–5) night-time bowel movements, 80% had either daytime or night-time incontinence and 80% used pads at a median follow up of 90 (range: 25–315) months. Conclusion: Pelvic EBRT administered prior to IPAA is associated with acceptable long-term function outcome. However, when pelvic EBRT is given to an IPAA in situ, most patients experience poor long-term pouch function without pouch failure.

AB - Aim: Short-term morbidity and long-term functional outcome of patients with an ileal pouch-anal anastomosis (IPAA) exposed to pelvic external beam radiation therapy (EBRT) remains unknown. We report the largest series to date regarding the effects of pelvic EBRT on: (i) 30-day postoperative outcomes; and (ii) long-term functional outcome following IPAA. Method: A retrospective chart review was conducted of patients who received EBRT before or after IPAA between 1980 and 2017 across three international inflammatory bowel disease referral centres. Results: Nineteen patients were included. Indications for EBRT were rectal adenocarcinoma (n = 13), prostate adenocarcinoma (n = 4) or anal squamous cell carcinoma (ASCC) (n = 2). EBRT was given prior to IPAA in 12 (63%) patients and after IPAA in seven (37%). In EBRT before IPAA, patients had a median of 5 (range: 4–8) daytime bowel movements, 1 (range: 0–5) night-time bowel movement, no daytime incontinence, and only one patient used pads at a median follow up of 25 (range: 11–163) months; one patient underwent pouch excision 15 months after IPAA. In EBRT after IPAA, patients reported a median of 8 (range: 5–10) daytime and 2 (range: 0–5) night-time bowel movements, 80% had either daytime or night-time incontinence and 80% used pads at a median follow up of 90 (range: 25–315) months. Conclusion: Pelvic EBRT administered prior to IPAA is associated with acceptable long-term function outcome. However, when pelvic EBRT is given to an IPAA in situ, most patients experience poor long-term pouch function without pouch failure.

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