Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2016; 22(24): 5598-5608
Published online Jun 28, 2016. doi: 10.3748/wjg.v22.i24.5598
Colostomy is a simple and effective procedure for severe chronic radiation proctitis
Zi-Xu Yuan, Teng-Hui Ma, Huai-Ming Wang, Qing-Hua Zhong, Xi-Hu Yu, Qi-Yuan Qin, Jian-Ping Wang, Lei Wang
Zi-Xu Yuan, Teng-Hui Ma, Huai-Ming Wang, Qing-Hua Zhong, Xi-Hu Yu, Qi-Yuan Qin, Jian-Ping Wang, Lei Wang, Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510655, Guangdong Province, China
Zi-Xu Yuan, Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA 98109, United States
Author contributions: Yuan ZX and Ma TH contributed equally to this work; Yuan ZX, Ma TH and Wang L conceived and designed the study; Yuan ZX, Zhong QH, Yu XH, and Qin QY and Wang L conducted the experiments; Yuan ZX, Ma TH, Wang HM and Wang JP analyzed and interpreted the data; Yuan ZX, Ma TH and Wang L wrote and revised the manuscript; all authors approved the final version to be published.
Supported by National Natural Science Foundation of China, No. 81201581, No. 81573078 and No. 81372566; Support Program from Ministry of Science and Technology of China, No. 2014BAI09B06; and Natural Science Foundation of Guangdong Province, China, No. 2016A030311021.
Institutional review board statement: The study was approved by the Ethical Committee of the Sixth Affiliated Hospital of Sun Yat-Sen University and fulfilled the guidelines of the local responsible governmental agency.
Informed consent statement: Informed consent was waived due to the retrospective nature of this study.
Conflict-of-interest statement: The authors declare no conflicts of interests related to the publication of this study.
Data sharing statement: No additional data was available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lei Wang, MD, PhD, Professor, Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-Sen University, 26 Yuancunerheng Road, Guangzhou 510655, Guangdong Province, China. leiwangyinhu@163.com
Telephone: +86-20-38767131 Fax: +86-20-38254221
Received: March 13, 2016
Peer-review started: March 16, 2016
First decision: March 31, 2016
Revised: April 5, 2016
Accepted: May 4, 2016
Article in press: May 4, 2016
Published online: June 28, 2016
Processing time: 100 Days and 9.4 Hours
Abstract

AIM: To assess the efficacy and safety of diverting colostomy in treating severe hemorrhagic chronic radiation proctitis (CRP).

METHODS: Patients with severe hemorrhagic CRP who were admitted from 2008 to 2014 were enrolled into this study. All CRP patients were diagnosed by a combination of pelvic radiation history, clinical rectal bleeding, and endoscopic findings. Inclusion criteria were CRP patients with refractory bleeding with moderate to severe anemia with a hemoglobin level < 90 g/L. The study group included patients who were treated by diverting colostomy, while the control group included patients who received conservative treatment. The remission of bleeding was defined as complete cessation or only occasional bleeding that needed no further treatment. The primary outcome was bleeding remission at 6 mo after treatment. Quality of life before treatment and at follow-up was evaluated according to EORTC QLQ C30. Severe CRP complications were recorded during follow-up.

RESULTS: Forty-seven consecutive patients were enrolled, including 22 in the colostomy group and 27 in the conservative treatment group. When compared to conservative treatment, colostomy obtained a higher rate of bleeding remission (94% vs 12%), especially in control of transfusion-dependent bleeding (100% vs 0%), and offered a better control of refractory perianal pain (100% vs 0%), and a lower score of bleeding (P < 0.001) at 6 mo after treatment. At 1 year after treatment, colostomy achieved better remission of both moderate bleeding (100% vs 21.5%, P = 0.002) and severe bleeding (100% vs 0%, P < 0.001), obtained a lower score of bleeding (0.8 vs 2.0, P < 0.001), and achieved obvious elevated hemoglobin levels (P = 0.003), when compared to the conservative treatment group. The quality of life dramatically improved after colostomy, which included global health, function, and symptoms, but it was not improved in the control group. Pathological evaluation after colostomy found diffused chronic inflammation cells, and massive fibrosis collagen depositions under the rectal wall, which revealed potential fibrosis formation.

CONCLUSION: Diverting colostomy is a simple, effective and safe procedure for severe hemorrhagic CRP. Colostomy can improve quality of life and reduce serious complications secondary to radiotherapy.

Keywords: Chronic radiation proctitis; Rectal bleeding; Diverting colostomy; Quality of life; Serious complication

Core tip: The study describes the efficacy and safety of diverting colostomy in treating severe hemorrhagic chronic radiation proctitis. The procedure focuses on improving the severe refractory bleeding and reducing severe complications. The advantages of diverting colostomy are as follows: it acts effectively and rapidly in controlling severe bleeding that does not respond to conservative treatment; it is a simple procedure that can be conducted in many medical centers; and it can improve quality of life dramatically and reduce serious complications that occur secondary to radiotherapy.