Permanent colostomy wound: Aeromedical disposal

Abstract

Background: A 41-year-old test pilot from the fighter stream presented to the Institute of Aerospace Medicine (IAM) with carcinoma lower one-third of rectum (opted) and a history of 2 years of follow-up post-surgery. He was physically fit with a healthy stoma in the left iliac fossa region. There was no history of local recurrence or distance metastases of colorectal cancer (CRC). During his evaluation at IAM, the officer had completed the OPTRAM profile with a stomal guard in place and could do AGSM effectively. Considering the overall prognosis, which was found to be favorable, the pilot was recommended an upgradation to a restricted flying category in the type, subject to a 1 time waiver from Director General Medical Services (air). Discussion: According to the Indian Council of Medical Research consensus document for the management of CRC 2014, the annual incidence rate of colon cancer and rectal cancer in Indian male population is 4.4 and 4.1/100,000, respectively. Surgery is the primary treatment for such cancers and they are mostly curative. Multimodal therapy with neoadjuvant chemotherapy and radiotherapy is done to improve the survival rates. Latest reports published by the National Comprehensive Cancer Network for Rectal Cancer, Version 2.2018, Clinical Practice Guidelines in Oncology indicate that the peak mortality rates are currently down by 50% due to better treatment modalities. Depending on the site of primary tumor, the surgery might leave the patient with either a temporary or a permanent colostomy wound. Conclusion: There was no available record/published case report of any pilot being returned to the cockpit in military flying with a permanent stoma. This case was a first of its kind with respect to aeromedical decisionmaking. With mortality rates decreasing due to effective treatment for cancer, aeromedical decision in more such cases may be required in the future. This case will serve as a precedence in effectively returning trained aviators to the cockpit.