Surgical Treatment of Intestinal Complications after Radiotherapy and Surgery for Malignant Lymphoma and Carcinoma of the Testis

Abstract

The aim of this paper is the analysis of the complications occurred after surgical and radiological procedures, for staging and treatment of malignant lymphomas and testicular carcinoma with an evaluation of the possible efficacy of their surgical treatment. At the Istituto Nazionale dei Tumori of Milan during the period 1970-1976, 718 patients with malignant lymphomas were staged with laparosplenectomy; 444 of them received radiotherapy on the abdominal area. Laparosplenectomy was not performed on other 123 cases that were irradiated as well on the abdominal area. Retroperitoneal lymphadenectomy or explorative laparotomy were carried out in 98 patients with carcinoma of the testis and 46 of them received adjuvant radiotherapy; other 29 were irradiated without previous surgical procedures. After surgery alone morbidity and mortality rate were 2.7% and 0.73% respectively. The mortality/morbidity ratio was 26%. The incidence of complications after radiotherapy alone was 3.3%. No deaths followed the treatment. Combined treatment had a morbidity rate of 5.5% and mortality rate of 2%. The mortality/morbidity ratio was 37%. Complications were treated mainly by surgery: out of 50 interventions, 22 were intestinal resections. New secondary complications were however frequent (more than 50% after intestinal resection) especially in patients originally treated with laparosplenectomy or retroperitoneal dissection plus radiotherapy.