Rectal complications after modern radiation for prostate cancer: A colorectal surgical challenge

David Larson, Kristin Chrouser, Tonia Young-Fadok, Heidi Nelson

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

The operative management of rectal complications after radiation for prostate cancer has been incompletely studied. Our aim was to determine a logical surgical approach to these severe rectal complications. From an institutional database, we identified 5719 patients who were evaluated between 1990 and 2003 with a history of prostate cancer that was treated with radiation. Fourteen patients were identified from this group who underwent operative intervention for complications stemming from radiation. Charts were retrospectively reviewed for demographics, prostate cancer treatment, rectal symptoms, diagnostic techniques, operative interventions, and outcome. Ten patients (71%) had documented rectourethral fistulas. An additional four patients (29%) had either transfusion-dependent rectal bleeding or intractable fecal incontinence. Using a surgical algorithm, we proceeded with fecal diversion alone (20%), urinary and fecal diversion alone (50%), and primary repair with or without a tissue flap and fecal diversion (29%) in the 14 affected patients. Symptomatic improvement and resolution of these three complications occurred in 12 (85%) of patients. However, only 2 (15%) were able to retain their intestinal continuity to achieve this outcome. The introduction of a step-wise approach to this problem has resulted in symptomatic resolution in the majority of patients. However, this is achieved at the cost of permanent fecal and sometimes urinary diversion.

Original languageEnglish (US)
Pages (from-to)461-466
Number of pages6
JournalJournal of Gastrointestinal Surgery
Volume9
Issue number4
DOIs
StatePublished - Apr 1 2005

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Keywords

  • Radiation
  • Rectourethral fistula
  • Surgery

ASJC Scopus subject areas

  • Surgery

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