Enterocutaneous Fistula Associated with Malignancy and Prior Radiation Therapy

ABSTRACT

Enterocutaneous fistula (ECF) associated with cancer or radiation injury increases the complexity of normal management. Factors such as timing of additional adjuvant therapy or palliative care, technical considerations for operating on irradiated bowel, poor wound healing, increased risk of additional ECF, and decreased likelihood of spontaneous ECF closure all need to be considered in this scenario. Here the authors focus specifically on the management of ECF associated with cancer and/or radiation-induced injury to the bowel.

KEYWORDS

Enterocutaneous fistula - cancer - radiation injury - management

REFERENCES

• 1 Edmunds Jr L H, Williams G M, Welch C E. External fistulas arising from the gastro-intestinal tract.  Ann Surg. 1960;  152 445-471
• 2 Joyce M R, Dietz D W. Management of complex gastrointestinal fistula.  Curr Probl Surg. 2009;  46(5) 384-430
• 3 Chamberlain R S, Kaufman H L, Danforth D N. Enterocutaneous fistula in cancer patients: etiology, management, outcome, and impact on further treatment.  Am Surg. 1998;  64(12) 1204-1211
• 4 Paris F, Fuks Z, Kang A et al.. Endothelial apoptosis as the primary lesion initiating intestinal radiation damage in mice.  Science. 2001;  293(5528) 293-297
• 5 Zimmerer T, Böcker U, Wenz F, Singer M V. Medical prevention and treatment of acute and chronic radiation induced enteritis—is there any proven therapy? A short review.  Z Gastroenterol. 2008;  46(5) 441-448
• 6 Sauer R, Becker H, Hohenberger W German Rectal Cancer Study Group et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer.  N Engl J Med. 2004;  351(17) 1731-1740
• 7 Morganti A G, Massaccesi M, La Torre G et al.. A systematic review of resectability and survival after concurrent chemoradiation in primarily unresectable pancreatic cancer.  Ann Surg Oncol. 2010;  17(1) 194-205
• 8 Rogers L, Siu S S, Luesley D, Bryant A, Dickinson H O. Adjuvant radiotherapy and chemoradiation after surgery for cervical cancer.  Cochrane Database Syst Rev. 2009;  (4) CD007583
• 9 Stratton K L, Chang S S. Locally advanced prostate cancer: the role of surgical management.  BJU Int. 2009;  104(4) 449-454
• 10 Lynch A C, Delaney C P, Senagore A J, Connor J T, Remzi F H, Fazio V W. Clinical outcome and factors predictive of recurrence after enterocutaneous fistula surgery.  Ann Surg. 2004;  240(5) 825-831
• 11 Gordon P H. Principles and practice of surgery for the colon, rectum, and anus. In: Gordon PH, Nivatvongs S Principles and Practice of Surgery for the Colon, Rectum, and Anus. New York; Informa Health Care 2007: 104-134
• 12 Corman M L. Colon and Rectal Surgery. Philadelphia; Lippincott Williams & Wilkins 2005
• 13 Kozelsky T F, Meyers G E, Sloan J A North Central Cancer Treatment Group et al. Phase III double-blind study of glutamine versus placebo for the prevention of acute diarrhea in patients receiving pelvic radiation therapy.  J Clin Oncol. 2003;  21(9) 1669-1674
• 14 Meissner K. Late radiogenic small bowel damage: guidelines for the general surgeon.  Dig Surg. 1999;  16(3) 169-174
• 15 Giantonio B J, Catalano P J, Meropol N J Eastern Cooperative Oncology Group Study E3200 et al. Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200.  J Clin Oncol. 2007;  25(12) 1539-1544
• 16 Sandler A, Gray R, Perry M C et al.. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer.  N Engl J Med. 2006;  355(24) 2542-2550
• 17 Wedam S B, Low J A, Yang S X et al.. Antiangiogenic and antitumor effects of bevacizumab in patients with inflammatory and locally advanced breast cancer.  J Clin Oncol. 2006;  24(5) 769-777
• 18 Kindler H L, Friberg G, Singh D A et al.. Phase II trial of bevacizumab plus gemcitabine in patients with advanced pancreatic cancer.  J Clin Oncol. 2005;  23(31) 8033-8040
• 19 Yang J C, Haworth L, Sherry R M et al.. A randomized trial of bevacizumab, an anti-vascular endothelial growth factor antibody, for metastatic renal cancer.  N Engl J Med. 2003;  349(5) 427-434
• 20 Scappaticci F A, Fehrenbacher L, Cartwright T et al.. Surgical wound healing complications in metastatic colorectal cancer patients treated with bevacizumab.  J Surg Oncol. 2005;  91(3) 173-180
• 21 Heinzerling J H, Huerta S. Bowel perforation from bevacizumab for the treatment of metastatic colon cancer: incidence, etiology, and management.  Curr Surg. 2006;  63(5) 334-337
• 22 Sugarbaker P H. Cytoreductive surgery and peri-operative intraperitoneal chemotherapy as a curative approach to pseudomyxoma peritonei syndrome.  Eur J Surg Oncol. 2001;  27(3) 239-243
• 23 Esquivel J, Sticca R, Sugarbaker P Society of Surgical Oncology Annual Meeting et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement.  Ann Surg Oncol. 2007;  14(1) 128-133
• 24 Jaehne J. Cytoreductive procedures-strategies to reduce postoperative morbidity and management of surgical complications with special emphasis on anastomotic leaks.  J Surg Oncol. 2009;  100(4) 302-305
• 25 Yan T D, Morris D L. Cytoreductive surgery and perioperative intraperitoneal chemotherapy for isolated colorectal peritoneal carcinomatosis: experimental therapy or standard of care?.  Ann Surg. 2008;  248(5) 829-835
• 26 Roviello F, Marrelli D, Neri A et al.. Treatment of peritoneal carcinomatosis by cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion (IHCP): postoperative outcome and risk factors for morbidity.  World J Surg. 2006;  30(11) 2033-2040, discussion 2041–2042
• 27 Schmidt S, Chevallier P, Bessoud B et al.. Diagnostic performance of MRI for detection of intestinal fistulas in patients with complicated inflammatory bowel conditions.  Eur Radiol. 2007;  17(11) 2957-2963
• 28 Salerno G, Daniels I R, Moran B J, Wotherspoon A, Brown G. Clarifying margins in the multidisciplinary management of rectal cancer: the MERCURY experience.  Clin Radiol. 2006;  61(11) 916-923
• 29 Brown G, Daniels I R. Preoperative staging of rectal cancer: the MERCURY research project.  Recent Results Cancer Res. 2005;  165 58-74
• 30 Outwater E, Schiebler M L. Pelvic fistulas: findings on MR images.  AJR Am J Roentgenol. 1993;  160(2) 327-330
• 31 Bartram C, Buchanan G. Imaging anal fistula.  Radiol Clin North Am. 2003;  41(2) 443-457
• 32 Semelka R C, Hricak H, Kim B et al.. Pelvic fistulas: appearances on MR images.  Abdom Imaging. 1997;  22(1) 91-95
• 33 Pilleul F, Godefroy C, Yzebe-Beziat D, Dugougeat-Pilleul F, Lachaux A, Valette P J. Magnetic resonance imaging in Crohn's disease.  Gastroenterol Clin Biol. 2005;  29(8-9) 803-808
• 34 Albert J G, Martiny F, Krummenerl A et al.. Diagnosis of small bowel Crohn's disease: a prospective comparison of capsule endoscopy with magnetic resonance imaging and fluoroscopic enteroclysis.  Gut. 2005;  54(12) 1721-1727
• 35 Gourtsoyiannis N C, Grammatikakis J, Papamastorakis G et al.. Imaging of small intestinal Crohn's disease: comparison between MR enteroclysis and conventional enteroclysis.  Eur Radiol. 2006;  16(9) 1915-1925
• 36 Masselli G, Casciani E, Polettini E, Lanciotti S, Bertini L, Gualdi G. Assessment of Crohn's disease in the small bowel: Prospective comparison of magnetic resonance enteroclysis with conventional enteroclysis.  Eur Radiol. 2006;  16(12) 2817-2827
• 37 Kwon S H, Oh J H, Kim H J, Park S J, Park H C. Interventional management of gastrointestinal fistulas.  Korean J Radiol. 2008;  9(6) 541-549
• 38 Chapman R, Foran R, Dunphy J E. Management of intestinal fistulas.  Am J Surg. 1964;  108 157-164
• 39 Schecter W P, Hirshberg A, Chang D S et al.. Enteric fistulas: principles of management.  J Am Coll Surg. 2009;  209(4) 484-491
• 40 Hill G L. Operative strategy in the treatment of enterocutaneous fistulas.  World J Surg. 1983;  7(4) 495-501
• 41 Cameron J. Current Surgical Therapy. St. Louis, MO; Mosby 2001
• 42 Galie K L, Whitlow C B. Postoperative enterocutaneous fistula: when to reoperate and how to succeed.  Clin Colon Rectal Surg. 2006;  19(4) 237-246
• 43 Quah H M, Chou J F, Gonen M et al.. Identification of patients with high-risk stage II colon cancer for adjuvant therapy.  Dis Colon Rectum. 2008;  51(5) 503-507
• 44 Lavery I C, de Campos-Lobato L F. How to evaluate and identify stage II colon cancer patients requiring referral to a medical oncologist: a surgeons perspective.  Oncology (Williston Park). 2010;  24(1, Suppl 1) 14-16
• 45 Willett C G, Czito B G. Chemoradiotherapy in gastrointestinal malignancies.  Clin Oncol (R Coll Radiol). 2009;  21(7) 543-556
• 46 Colombo N, Parma G, Zanagnolo V, Insinga A. Management of ovarian stromal cell tumors.  J Clin Oncol. 2007;  25(20) 2944-2951
• 47 Chemoradiotherapy for Cervical Cancer Meta-Analysis Collaboration . Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials.  J Clin Oncol. 2008;  26(35) 5802-5812
• 48 Marks G, Mohiudden M. The surgical management of the radiation-injured intestine.  Surg Clin North Am. 1983;  63(1) 81-96
• 49 Galland R B, Spencer J. Radiation-induced gastrointestinal fistulae.  Ann R Coll Surg Engl. 1986;  68(1) 5-7
• 50 Galland R B, Spencer J. Surgical management of radiation enteritis.  Surgery. 1986;  99(2) 133-139
• 51 Cooke S A, de Moor N G. The surgical treatment of the radiation-damaged rectum.  Br J Surg. 1981;  68(7) 488-492
• 52 Galland R B, Spencer J. Surgical aspects of radiation injury to the intestine.  Br J Surg. 1979;  66(2) 135-138
• 53 Dworak J, Dietz D W. Radiation enteritis and proctitis. In: Fazio VW, Church JM, Delaney C Current Therapy in Colon and Rectal Surgery. Philadelphia, PA; Elsevier Mosby 2004: 491-498
• 54 Landim F M, Tavares J M, Costa M L, Landim R M, Feitosa R G. Complex abdominal wall reconstruction after radiation therapy: a full-thickness defect was repaired with a rectus femoris myofasciocutaneous flap.  Am J Obstet Gynecol. 2009;  200(1) 116.e1-116.e3