Effect of omental pedicle hammock in protection against radiation-induced enteropathy in patients with rectal cancer
- 23 Downloads
PURPOSE: The aim of this nonrandomized study was to assess effects against radiation-induced enteropathy by constructing an omental pedicle hammock, thus isolating the small bowel outside the pelvis. METHODS: Since 1991, 32 patients received the omental pedicle hammock procedure as an adjunct to definitive cancer surgery, and the perioperative experiences and toxic effects of radiation therapy were evaluated and compared with 25 patients who received pelvic floor reperitonealization only. RESULTS: There were no surgical complications related to the omental hammock procedure. Contrary to control cases that showed the bowel to adhere deeply in the pelvis, exclusion of the small bowel from the pelvic cavity demonstrated by contrast study was successful in all except four cases of a segment of bowel loop descent within the radiation portals. According to acute and late radiation morbidity scoring criteria, 26 patients (81 percent) scored Grade 0 in the treatment group, whereas only 3 patients (12 percent) scored Grade 0 in the control group (P<0.01) in the acute phase, and 28 patients (88 percent) of Grade 0 in the former group and 15 (60 percent) in the latter (P<0.025) in late phase. There has been no case of radiation-induced enteropathy requiring surgical treatment. CONCLUSION: The technique of bowel exclusion by pedicle omental hammock would make it possible to use higher doses of postoperative pelvic radiation therapy without fear of complications from radiation-induced enteropathy.
Key wordsRectal cancer Radiation therapy Omental pedicle hammock Radiation-induced enteropathy
Unable to display preview. Download preview PDF.
- 1.Gastrointestinal Tumor Study Group. Prolongation of the disease-free interval in surgically treated rectal carcinoma. N Engl J Med 1985;312:1465–72.Google Scholar
- 3.Dasmahapatra KS, Swaminathan AP. The use of a biodegradable mesh to prevent radiation associated small bowel injury. Arch Surg 1991;126:336–9.Google Scholar
- 6.Perez CA, Brady LW. Overview. In: Perez CA, Brady LW, eds. Principles and practice of radiation oncology, 2nd ed. Philadelphia: JB Lippincott, 1992:51–5.Google Scholar
- 7.Russ JE, Smoron GL, Gagnon JD. Omental transposition flap in colorectal carcinoma: adjunctive use in prevention and treatment of radiation complications. Int J Radiat Oncol Biol Phys 1984;10:55–62.Google Scholar
- 10.Valle G, Ferrarie G. Use of omentum to contain the intestine in pelvic exenteration. Surg Gynecol Obstet 1969;33:772–5.Google Scholar
- 15.Devereux DF, Eisenstat T, Zinkin L. The safe and effective use of postoperative radiation therapy in modified Astler Coller stage C3 rectal cancer. Cancer 1989;163:2393–6.Google Scholar