Surgical management of intestinal complications of radiotherapy for gynecological malignancies.

: Sixty patients treated for gynecological malignancies with radiation therapy and operated upon because of late intestinal complications of the treatment were studied. Among patients irradiated for cervical carcinoma an incidence of 3.2% of operated intestinal lesions was encountered. Fifty-nine per cent of the women had a history of previous pelvic inflammatory disease on pelvic surgery. The most common symptoms leading to surgery were mechanical subileus/ileus, pain and fistulas. The majority of patients (53%) were operated upon within 2 years after irradiation, but an interval up to 20 years was recorded. 50% were operated upon within 2 years after irradiation, but an interval up to 20 years was recorded. 50% were reoperated during follow-up. Intestinal resections (38%) and by-passes (15%) were the most frequent surgical procedures at first operation. 57% of the patients were operated upon due to acute conditions and 31% were due to chronic problems, 12% due to tumour suspicion. An operation mortality rate of 5% was found. No obvious correlation could be seen between accumulated irradiation dose and severity of complications. The results of surgical intervention and complications are analysed and different strategies in handling these patients discussed.