Radiotherapy for cervical cancer has made great progress in recent years, but the incidence of radiotherapy-associated intestinal injury, especially the serious long-term complication, intestinal obstruction, has also increased greatly. In particular, some patients with advanced cervical cancer have lost the opportunity for surgery, but high-dose radiotherapy with concurrent chemotherapy can still lead to long-term survival, yet it is accompanied by severe chronic radiation damage to the intestine.
The characteristic pathological changes of chronic radiation enteritis are occlusive small artery endolitis and intestinal wall fibrosis. The incidence of chronic radiation enteritis has been estimated abroad: of the 100,000 cases of radiotherapy for abdominal or pelvic tumors in the United States each year, 5-15% develop chronic radiation enteritis, and about 50% of these 50,000-150,000 require surgery.
The onset of chronic radiation enteritis mostly occurs 6-24 months after radiotherapy, and individual cases can occur up to 20 years later. Patients are first seen for obstruction about 1 year and 6 months after the end of radiotherapy, and most have a history of transient diarrhea during radiotherapy.
The radiologically damaged bowel segment causing intestinal obstruction is usually in the terminal ileum, accounting for more than 70% of cases in the literature, and the majority of our cases are in the terminal ileum. This is mainly because different parts of the intestine have different degrees of tolerance to radiation damage. Although the rectum receives a large radiation dose, it tolerates radiation damage much better than the small intestine; secondly, the pelvic surgical wound formed after cervical cancer surgery can form adhesions with the adjacent ileum and fix the ileum in the radiation area.
Ideally, surgery for chronic radiation enteritis and intestinal obstruction is performed by removing the radiation-damaged intestinal segment and performing GI reconstruction at the same time. The anastomotic strategy and technique of GI reconstruction is very important. Intraoperative placement of a double intraperitoneal trocar, close postoperative observation and timely management, and nutritional support are particularly important. The first surgery has a significant impact on the prognosis and a specialized surgical center and experienced surgeons can play a significant role in reducing serious surgical complications in patients.