Bull Cecilia, Morén Amelie Toft, Skokic Viktor, Wilderäng Ulrica, Malipatlolla Dilip, Alevronta Eleftheria, Dunberger Gail, Sjöberg Fei, Bergmark Karin, Steineck Gunnar
Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden.
Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden.
Adv Radiat Oncol. 2023 Jun 27;9(1):101303. doi: 10.1016/j.adro.2023.101303. eCollection 2024 Jan.
To determine the effects of intra-abdominal surgery on the intensities of 5 radiation-induced intestinal syndromes in survivors of pelvic cancer.
The analysis included 623 women born in 1927 or later who had survived cancer. They all had received external radiation therapy toward the pelvic area to treat gynecologic cancers. Information from 344 women who did not undergo irradiation, matched for age and residency, was also included. Main outcome measures after the surgical procedures were the intensity scores for 5 radiation-induced intestinal syndromes: urgency-tenesmus syndrome, fecal-leakage syndrome, excessive mucus discharge, excessive gas discharge, and blood discharge. The scores were based on symptom frequencies obtained from patient-reported outcomes and on factor loadings obtained from a previously reported factor analysis. Follow-up was 2 to 15 years after radiation therapy.
Among survivors of cancer, intra-abdominal surgery increased the intensity of the urgency-tenesmus syndrome, the fecal-leakage syndrome, excessive gas discharge, and blood discharge but had a negligible effect on mucus discharge. Intra-abdominal surgery had an especially negative effect on the urgency-tenesmus syndrome. Although the combination of appendectomy with 1 or more other intra-abdominal surgeries resulted in the highest score for all syndromes, appendectomy alone had weak to no effect. In women who did not undergo irradiation, a similar pattern was seen, albeit with much lower scores.
We found intra-abdominal surgery to be a risk factor among survivors of gynecologic cancer, increasing the intensity score of 4 out of 5 radiation-induced intestinal syndromes. During radiation therapy, it may be worthwhile to pay extra attention to the dose of unwanted ionizing radiation to the intestines if the patient previously has undergone intra-abdominal surgery.
确定腹部手术对盆腔癌幸存者5种放射性肠道综合征严重程度的影响。
分析纳入了623名1927年或之后出生的癌症幸存者。她们均接受过盆腔区域的外照射放疗以治疗妇科癌症。还纳入了344名年龄和居住地匹配但未接受过放疗的女性的信息。手术操作后的主要观察指标是5种放射性肠道综合征的严重程度评分：尿急-里急后重综合征、粪便渗漏综合征、黏液分泌过多、气体排出过多和便血。评分基于患者报告结局获得的症状频率以及先前报道的因子分析获得的因子载荷。放疗后随访2至15年。
在癌症幸存者中，腹部手术增加了尿急-里急后重综合征、粪便渗漏综合征、气体排出过多和便血的严重程度，但对黏液分泌过多的影响可忽略不计。腹部手术对尿急-里急后重综合征有特别负面的影响。虽然阑尾切除术与1种或更多其他腹部手术联合导致所有综合征的评分最高，但单独阑尾切除术的影响微弱或无影响。在未接受放疗的女性中也观察到类似模式，尽管评分低得多。
我们发现腹部手术是妇科癌症幸存者中的一个危险因素，增加了5种放射性肠道综合征中4种的严重程度评分。在放疗期间，如果患者先前接受过腹部手术，额外关注对肠道的不必要电离辐射剂量可能是值得的。
