Aggressive initial surgery for chronic radiation enteritis: long-term results of resection vs non-resection in 44 consecutive cases.

Objective: One third of patients with chronic radiation enteritis will require surgery. There is, however, no consensus on the best surgical strategy. The long-term results of intestinal resection vs a `conservative' procedure, including stoma, bypass, and/or adhesiolysis, were reviewed with special reference to reoperation rates and the ultimate need for long-term parenteral nutrition.

Methods: Forty-four patients operated for chronic radiation enteritis were divided into two groups: Group I resection (n = 21) and Group II conservative (n = 23). Twenty patients had received preoperative total parenteral nutrition, 16 (76%) in the resection group vs four (17%) in the conservative group (P < 0.001). In the resection group, intestinal resection was combined with a stoma in six patients. In the conservative group, 10 patients underwent adhesiolysis, five a bypass procedure, and eight diverting stoma.

Results: Post-operative mortality was similar in both groups (9.5% vs 8.5%). Mean follow up was 53 and 55 months for Group I and Group II, respectively. The reoperation rate was significantly lower in Group I: 9 (47%) vs 19 (86%), P < 0.01. Although not significant, the ultimate need for long-term parenteral nutrition rate was lower in Group I than in Group II: 6 (32%) vs 10 (48%).

Conclusions: Resection resulted in better treatment outcomes than `conservative' surgery for chronic radiation enteritis.