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PubMed1987

An ideal operation for diverticulitis of the colon.

A review has been made of the records of 208 patients operated on for complications of diverticulitis of the colon. One hundred forty patients had emergency operations and 68, elective operations. Resection and anastomosis, with or without temporary diverting colostomy, practiced in the majority of emergency cases in the earlier years covered in this review, has been replaced in the past 10 years by resection without anastomosis. Transverse colostomy, first carried out as part of a three-stage procedure, has been partially replaced by descending colostomy in the past few years. A comparison of the findings at exploration in patient who underwent resection, anastomosis, and temporary transverse colostomy with the findings in those who had the Hartmann procedure showed a slightly higher incidence of free perforation or abscess in those who had the former procedure. The hospital stay was similar in the two groups, but time in the operating room and days of disability were much less in the resection group. Only 14 of the 23 patients who survived the Hartmann procedure underwent restoration of continuity, whereas all of those in the resection group did. Follow-up of the patients who had descending colostomy showed that only 6 of 11 surviving patients underwent resection and anastomosis, but that inflammation regularly subsided, and all those with continent sphincters under age 80 eventually had restoration of continuity. This is in contrast to a more than 20 percent incidence of permanent stomas in the transverse colostomy group, all of which were in patients under age 70.

Aged↗
PubMed2003

The morbidity of penetrating colon injury.

UNLABELLED: The purpose of this study is to define the current morbidity and mortality associated with penetrating colon injury and to determine the impact of management strategy on outcome. METHODS: A retrospective review was performed of all penetrating colon injuries managed at a level I trauma center (1990-2000), n=186. Stepwise logistic regression was used to determine the independent predictors for colostomy and morbidity following colon injury. RESULTS: Fifty-three percent of the patients were managed with primary repair or anastomosis while 47% received a colostomy. Independent predictors of colostomy included gunshot wound (GSW), degree of peritoneal contamination, and location of injury. The complication rate for patients requiring a colostomy was 57% versus 42% for the primary repair group, P=0.01. When adjusted for injury severity and hypotension, the presence of a colostomy was not associated with a significant increase in the complication rate (OR 1.7, 95% CI: 0.9-3.25). Independent predictors for the development of intra-abdominal abscess were hypotension on admission (OR 2.4, 95% CI: 1.1-5.8) and penetrating abdominal trauma index (PATI) score >25 (OR 4.2, 95% CI: 2.0-8.9). The complication rate for colostomy takedown was 17%. CONCLUSION: Penetrating colon injury carries a high rate of infectious morbidity. The development of infectious complications is related to the injury severity and haemodynamic status of the patient, not the type of operation performed.

Abdominal Abscess↗
PubMed1999

The role of intestinal stoma in patients with spinal cord injury.

In the long term following spinal cord injury, bowel dysfunction causes major physical and psychological problems. A retrospective review of intestinal stomas performed in patients with spinal cord injury over a 10 year period was performed to investigate their role in alleviating these problems. Twelve patients underwent left iliac fossa end colostomy and two patients right iliac fossa end ileostomy. The mean age of patients at operation was 54.8 years (20-65), and the mean time from injury to stoma formation was 15 years (2-37). The mean period of unsatisfactory bowel management before stoma formation was 5.4 years (1.5-2.5). Following colostomy the mean time spent on bowel care per week fell from 8.8 h (0.6-12.2) to 1.4 h (0.3-3.5) and independence in bowel care rose from 50 to 92%. All patients stated that their bowel care was easier and 83% said their independence had increased. Ninety-two per cent wished colostomy had been offered earlier and no patient undergoing colostomy wanted it reversed. The most common complication following colostomy was exclusion colitis. The mean time of follow-up post colostomy formation was 38 months (7-130). Formation of an intestinal stoma is a safe, effective and well accepted treatment for selected patients with intractable problems of bowel management following spinal cord injury.

Adult↗
PubMed1979

Management of perforating colon trauma: randomization between primary closure and exteriorization.

During a 44 month trial, 268 patients with wounds of the colon were entered into a prospective, randomized, nonblinded study. Consideration for primary closure demanded that: preoperative shock was never profound, blood loss was less than 20% of estimated normal volume, no more than two intra-abdominal organ systems had been injured, fecal contamination was minimal, operation was begun within eight hours, and wounds of colon and abdominal wall were never so destructive as to require resection. Once such criteria had been satisfied, colon wound management was dictated by last digit in the randomly assigned hospital number; odd indicated primary closure; even, exteriorization of the wound or primary closure with protection by a proximal vent. Results obtained in 139 determinant patients eligible for randomization revealed that primary closure (67 patients) had a lower infection rate of the incision (48% vs S7%, p > 0.05) and a still lower infection rate for the abdomen proper (15% vs 29%, p < 0.05) on comparison to the 72 patients with a randomized colostomy. Morbidity otherwise for the randomized colostomy was tenfold greater than if a primary closure had been performed. Average postoperative stay was six days longer (p < 0.01) if a colostomy had been created, exclusive of subsequent hospitalization for colostomy closure; while the total extra cost for management of the colon wound by colostomy was approximately $2,700.00. Although immediate mortalities were identical, one late death occurred following colostomy closure. These data not only confirm the safety of primary closure for colon wounds in selected cases, but also indicate that such should become the preferred method of treatment whenever specific criteria have been met.

Clinical Trials as Topic↗
PubMed1986

The injured colon.

Controversy continues regarding the initial management of civilian colon injuries. The main issues are the safety of colostomy versus the desirability of primary repair and the role of exteriorized repair. From 1979 through 1984, 727 patients with injuries to the colon were treated at a large urban trauma center. Ninety-seven per cent of injuries were caused by penetrating wounds. Ten patients died in the operating room prior to repair of the colon wound. For patients who survived long enough to have their injury treated, 52.4% were treated by primary repair, 32.9% were treated with colostomies, and 14.6% were treated with exteriorized repair. Of the factors that have been stated to influence decision making, the extent of the colon injury was the most important. Location, number, and type of associated injuries, fecal contamination, and shock were less important. However, none of these latter factors mandated performance of a colostomy. The overall mortality rate for the series was 9.9%. Forty-one out of 70 deaths occurred within the first 48 hours and were due to shock and hemorrhage. The mortality rate for primary repair was significantly lower than that for colostomies (p less than 0.01). The presence of shock and age greater than 40 were significant factors influencing mortality (p less than 0.01). Mortality also was directly related to the number and type of associated abdominal injuries. Abdominal abscess also occurred significantly less often in patients treated with primary repair than in those with colostomies (p less than 0.01). The use of exteriorized repair was successful in avoiding colostomy in 59% of patients. Primary repair can be performed with minimal morbidity and mortality and should be the mainstay of treatment for civilian colon injuries.

Adolescent↗
PubMed1989

[Surgical tactics in complicated sigmoid diverticulitis].

Between January 1972 and February 1988 139 admissions (136 patients) for diverticulitis were registered. Treatment remained conservative in 47 cases. 23 cases underwent elective surgery. In 69 patients emergency-laparotomy had to be done. In 41 cases (3 deaths) the abdomen was washed out and drained, followed by a proximal colostomy. In 23 of these patients a free perforation had to be oversewn. 6 patients were treated by Hartmann resection (1 death). Primary resection, anastomosis and proximal colostomy were performed in 15 cases. 3 patients underwent exterritorization and resection. 4 patients with colonic ileus were initially treated by colostomy alone. There were 2 late deaths both from pulmonary embolism. Of the 63 patients who had a colostomy constructed 4 (6.3%) never had the stoma closed. There were 2 persistent stomas in the 41 patients who had a preliminary colostomy alone (4.9%) and the incidence of persistent stoma in 5 patients who had a Hartmann resection was 40% (2 cases). -The three-stage resection makes good results, provided that a free perforation is solidly oversewn to prevent further fecal contamination. Primary resection with anastomosis and proximal colostomy, which is more and more used in suitable cases, considerably shortens duration of treatment. Hartmann resection remains second choice because of the known high incidence of persistent stoma. It is submitted to surgeon's experience to choose at any situation the best procedure regarding age and general state, local findings and extent of peritonitis. With this tactic hospital lethality of emergency operation was 4 of 69 patients (5.8%), overall lethality 6 (8.7%). Intestinal continuity was restored in 94% of surviving patients.

Adult↗
PubMed1980

[Answers to ten questions often asked by colostomized patients (author's transl)].

Wishing to help practitioners, who often are slightly puzzled by the technicalities of intestinal surgery, the authors offer short answers to the ten questions most frequently asked by colostomized patients, i.e.: where is my colostomy located? How was it made? Is there any possibility of passing motions through by natural anus? What does continent colostomy mean? What are the basic rules for the maintenance of colostomy? How to choose the colostomy bag? What to do in case of intolerance to the bag? Must I follow a restrictive diet? When can my colostomy be suppressed? Can I resume work with a colostomy? No effort should be spared to prevent a colostomized patient from becoming an invalid and to help him lead a normal life.

Colostomy↗
PubMed1994

[Medicosocial consequences of permanent digestive stomas. A national multicenter retrospective study].

OBJECTIVES: To evaluate the medical (sexual dysfunction, psychological adjustment, stoma care) and social (working life, family life, leisure) consequences of definitive ileostomies or colostomies. METHOD: From February 1992 to May 1992, 1082 live patients (978 colostomies and 104 ileostomies) who had undergone surgery at least 6 months earlier were assessed in a multicentre national inquiry. RESULTS: More than 20% of the patients had not been informed before surgery of the possibility of a definitive stoma. In half of the cases, the stoma was well accepted psychologically and patient's primary reactions improved with time, especially in patients with ileostomy (p < 0.01) and patients under 60 years of age (p < 0.001). Patients were satisfied with their stoma appliance in 94% of the cases. Only 31% with colostomy performed irrigations. Life style was altered in 43% of the patients, especially those with ileostomies (p < 0.001). Sexual activity was disturbed in 55% of the colostomy patients and working life in 63% of the ileostomy patients. One-fourth of the patients were often followed by an enterostomal therapist and one-third were members of ostomate associations. CONCLUSIONS: Ileostomy appears to be more disabilitating than colostomy due to patient age and, unlike colostomy, the impossibility of irrigation. These findings emphasize the contribution of enterostomal therapy and the justified role of ostomate associations.

Activities of Daily Living↗
PubMed2002

Sacrococcygeal teratoma.

This retrospective study details our experience regarding 72 patients with sacrococcygeal teratoma treated over a period of 17 years. The sex incidence was nearly equal, but there was a high proportion of Altmann type IV tumors. A preliminary colostomy before combined abdominosacral excision of large type III and IV lesions reduced morbidity. Sixty-six percent of the patients presented beyond the neonatal period; 14 had been treated elsewhere for bowel/urinary obstruction. Imaging studies included radiography, abdominal ultrasound, computed tomography, and magnetic resonance imaging (after 1995). In 60 patients the tumor was excised via the sacral route, 11 had a preliminary colostomy, and 1 had a vesicostomy. Eight children (5 with malignant lesions) required abdominosacral excision. After 1990, serial estimation of serum alpha-fetoprotein (AFP) was used to monitor tumor recurrence. There were 34 male and 38 female patients (age range 3 days-12 years); 47 had benign tumors, of which 42 were excised through the sacral route. Three patients underwent a preliminary colostomy and abdominosacral excision of the tumor with subsequent colostomy closure. There were 4 deaths in this group; no recurrence was seen in the surviving children with benign tumors. Twenty-five patients had malignant teratomas. In 18 of these the tumor was excised via the sacral route and 5 underwent abdominal-sacral excision. Eight had a preliminary colostomy and chemotherapy followed by excision of the residual tumor and colostomy closure. None of the initial 14 patients with malignant lesions survived beyond 2 years. Of the latter 11 (who received cisplatinum-based chemotherapy), 10 were alive 1 year after surgery. One patient is currently on preoperative chemotherapy and another developed recurrence of the tumor. The overall follow-up ranged from 3 months to 8 years; there has been no complaint of functional neurological deficit in any of the patients. As intrapelvic tumors tend to have a delayed diagnosis, this can be avoided by performing a rectal examination. There should be no recurrence after excision of a benign teratoma. Cisplatinum-based chemotherapy has improved the survival of patients with malignant tumors.

Adolescent↗
PubMed2000

Sphincter-saving treatment in epidermoid anal cancer: cooperative analysis of 142 patients in five German university surgical centers.

Five southern German university centers cooperated in comparing the effect of surgical vs. nonsurgical therapy strategies on survival and sphincter preservation in the treatment of anal cancer. A standardized questionnaire was used to evaluate retrospectively (mean follow-up 30 months) treatment strategy and outcome (survival, colostomy rate, colostomy-free survival) in patients treated between 1987 and 1996. Of the 142 patients 65% had squamous cell, 20% basaloid, 6% adeno-, and 1% undifferentiated carcinoma (8% histology not recorded); 9% were classified in UICC stage I, 37% in stage II, 25% in stage III, and 4% in stage IV (25% not recorded). Primary treatment consisted of local excision (10%), excision plus radio- and/or chemotherapy (17%), radiotherapy (20%), radiochemotherapy (28%), or colostomy with or without resection, radiotherapy, and chemotherapy (23%). We observed no difference between these treatment groups in overall (P = 0.43) or colostomy-free survival (P = 0.14, log-rank). Primary colostomy was prevented in 77% of cases and decreased over the years. Mean overall survival (in months) was 42 in stage I, 38 in stage II, and 25 in stage III (P = 0.0013); mean colostomy-free survival was 36 in stage I, 26 in stage II, and 16 in stage III (P = 0.0021, log-rank). Outcome was not significantly related to therapeutic strategy (surgery or radio-chemotherapy. Primary surgical and nonsurgical strategies in treating anal cancer thus produced similar results, although radiochemotherapy is usually recommended for sphincter-endangering anal cancer. Challenges to be met in the future include the prevention of metastasis and long-term preservation of anal sphincter function.

Adenocarcinoma↗
PubMed2002

Systematic review of dynamic graciloplasty in the treatment of faecal incontinence.

BACKGROUND: The aim of this systematic review was to compare the safety and efficacy of dynamic graciloplasty with colostomy for the treatment of faecal incontinence. METHODS: Two search strategies were devised to retrieve literature from the Medline, Current Contents, Embase and Cochrane Library databases up until November 1999. Inclusion of papers depended on a predetermined protocol, independent assessments by two reviewers and a final consensus decision. English language papers were selected. Acceptable study designs included randomized controlled trials, controlled clinical trials and case series. Forty papers met the inclusion criteria. They were tabulated and critically appraised in terms of methodology and design, outcomes, and the possible influence of bias, confounding and chance. RESULTS: No high-level evidence was available and there were no comparative studies. Mortality rates were around 2 per cent for both graciloplasty and colostomy. Morbidity rates reported for graciloplasty appear to be higher than those for colostomy. Dynamic graciloplasty was clearly effective at restoring continence in between 42 and 85 per cent of patients, whereas colostomy is, by its design, incapable of restoring continence. However, dynamic graciloplasty is associated with a significant risk of reoperation. CONCLUSION: While dynamic graciloplasty appears to be associated with a higher rate of complications than colostomy, it is clearly a superior intervention for restoring continence in some patients. It is recommended that a comparative, but non-randomized, study be undertaken to evaluate the safety of dynamic graciloplasty in comparison to colostomy, and that the procedure should be performed only in centres where it is carried out routinely.

Anal Canal↗
PubMed1992

[Postoperative morbidity and mortality of infectious complications of colonic diverticulosis: multifactorial study].

The objective of this study was to determine parameters influencing the mortality due to postoperative adverse events, by taking into account surgical techniques and many other perioperative parameters. From 1967 to 1989, 83 patients were operated for pericolic abscess (level 1, n = 22), pelvic abscess (level 2, n = 38) purulent peritonitis (level 3, n = 16) and fecal peritonitis (level 4, n = 7). Surgical techniques were: first colostomy with drainage (n = 21), first resection without immediate anastomosis (n = 34), and first resection with immediate anastomosis (n = 28). The overall complications were 51% (n = 42) with a mortality of 28% (n = 23). During univariate analysis, variables linked to postoperative complications were neurologic events (p < 0.0001), cirrhosis (p = 0.01), current treatment by steroids (p = 0.007), infectious level (p = 0.002), first colostomy (p = 0.005) and first resection with anastomosis (p = 0.007). Postoperative mortality was linked with neurologic events (p < 0.0001), age (p = 0.005), infectious level (p = 0.04), first colostomy (p = 0.005), and first resection with anastomosis (p = 0.0012). Logistic regression determined 3 independent variables influencing complications: neurologic events (p < 0.0001), first colostomy (p = 0.01), and infectious level (p = 0.002). The mortality determined by multivariate analysis was dependent on 3 variables: neurologic events (p < 0.0001) first colostomy (p = 0.007) and age (p = 0.01). The adjusted relative risk was 17 for neurologic events and 6 for first colostomy.

Abscess↗
PubMed1989

[Treatment of acute obstruction due to left colonic cancer].

Retrospective study on 47 patients (23 men, 24 women); mean age was 70.2 years. The mean delay of complete obstruction was 6.95 days. There were associated pathology and clinical factors of gravity in 53.2%, and local factors of gravity in 43.9% of all cases. Three steps surgery in 22 cases (46.8%), two steps in 14 cases (29.7%): 6 "ideal" colectomies (12.7%), 5 colostomies alone (10.6%). Mortality: 3 patients died (6.8%), post operative complications occurred in 22 patients (46.8%); morbidity due to colostomies itself was 37.4%. All first step-colostomies, except one, has been closed after colectomy. The mean duration of total stays in hospital was 31.5 days, according with the surgical procedure in one (14.3 days), two (37.9 days) or three (43.2 days) steps. Duration of complete obstruction, bioclinical status of patients, staging and complications of the cancer and surgeon's experience are determining therapeutic choices. The choice for colostomy as first step is the best policy. In this series the mortality of the colostomy as first step was none. It must be performed with elective incision, on free colic segment (transverse or sigmoid), with the simplest technical procedure (loop colostomy). Others surgical procedures have only peculiar indications.

Acute Disease↗
PubMed1993

Treatment of perforated sigmoid diverticulitis: a prospective randomized trial.

A prospective randomized trial was carried out on 62 patients with diffuse peritonitis from perforated diverticulitis of the left colon, comparing acute transverse colostomy, suture and omental covering of a visible perforation with acute resection without primary anastomosis. For purulent peritonitis the postoperative mortality rate was significantly higher after acute resection (six of 25) than after colostomy (none of 21). In those treated by acute resection, the mortality rate was not significantly higher after Hartmann's procedure (five of 15) than after exteriorization of both lumens (one of ten). The postoperative mortality rate in patients with faecal peritonitis did not differ significantly between colostomy (six of ten) and acute resection (two of six). Stomas became permanent in four of 25 patients with diverticulitis surviving acute colostomy and in seven of 22 surviving acute resection. Suture and transverse colostomy is superior to resection for purulent peritonitis because of the lower postoperative mortality rate and in spite of the shorter hospital stay in those surviving acute resection.

Adult↗
PubMed2000

Operative management of civilian rectal gunshot wounds: simpler is better.

Extraperitoneal rectal gunshot wounds have been managed with a variety of methods from simple diverting colostomy to combinations of rectal repair, proximal diversion, transperitoneal or presacral drainage, and distal bowel irrigation techniques. Treatment methodology is chosen based on anecdotal experience, and there is no clear evidence that any technique is superior to the others. The objective of this study was to compare 3 methods of managing civilian extraperitoneal gunshot wounds. Retrospective analysis of 30 consecutive patients with extraperitoneal rectal gunshot wounds was undertaken. Patients were treated with 1 of these 3 techniques: (1) simple diverting colostomy without rectal repair (group A, 12 patients); (2) diverting colostomy and rectal repair (group B, 12 patients); and (3) diverting colostomy and presacral drainage without repair (group C, 6 patients). Injury, hospital course, and outcome data were compared. The 3 groups were similar in age, injury severity, admission hemodynamics, preoperative and intraoperative time, blood loss, fecal contamination, and associated injuries. The overall incidence of complications was 27% (8/27): 25% (3/12) in group A, 33% (4/12) in group B, and 17% (1/6) in group C (p = NS). Complications directly associated with the rectal injury were found in 2 cases (7%): 1 group A patient developed a vesicorectal fistula and 1 group B patient developed a rectocutaneous fistula. For 10 patients with both rectal and bladder injuries, the complication rates for groups A, B, and C were 50%, 20%, and 0%, respectively (p = NS). No patient died. In conclusion, diverting colostomy without rectal repair or drainage appears to be safe for the management of most civilian retroperitoneal rectal gunshot wounds. Additional surgical maneuvers may be required for combined rectal and urinary trauma or other complex rectal injuries. Sound surgical principles, tailored to the individual case, should overrule any unproven dogmas.

Adolescent↗
PubMed2005

Pitfalls in the management of newborn cloacas.

Clinicians caring for newborns with persistent cloaca face significant challenges in the newborn period. Avoiding key pitfalls during this time can have dramatic implications. We reviewed the medical records of 361 patients with cloaca operated on at our institution and analyzed sequelae that resulted from incorrect management in the newborn period. Of 361 patients, 282 underwent primary operations at our institution, and 79 patients were referred to us after a failed repair at other institutions. Pitfalls in management during the newborn period included the following: (1) Failure to recognize and manage hydrocolpos, which occurred in 46 patients. Of these, three patients developed pyocolpos (two progressed to vaginal perforation), and 43 suffered from persistent bilateral hydronephrosis, megaureters, recurrent urinary tract infections, persistent acidosis, or failure to thrive due to undrained hydrocolpos. They underwent unnecessary urinary drainage procedures (nephrostomy, ureterostomy, cystostomy, or vesicostomy) in the newborn period. When the vagina was finally decompressed, all of these symptoms disappeared. (2) Colostomy or vesicostomy problems, which occurred in 50 patients. These included incorrect placement of the colostomy (too distal, which interfered with the pull-through) in 24 and colostomy prolapse in 23. Incompletely diverting loop colostomies led to urinary tract infections in 49 patients. Vesicostomy prolapse occurred in three patients. (3) Clinical misdiagnosis, which occurred in 42 patients. Six were incorrectly diagnosed as "intersex" and 36 as "rectovaginal fistula." In this group only the rectum was repaired, and the patients were left with a urogenital sinus that required reoperation. Proper management of a newborn with cloaca includes drainage of a hydrocolpos, which avoids unnecessary urinary diversions and pyocolpos. Our preferred colostomy is one with separated stomas, adequate distal bowel for the pull-through, and use of a proper technique to avoid prolapse. Correct clinical diagnosis of cloaca avoids problems during the definitive repair.

Cloaca↗
PubMed2003

Elective stoma construction improves outcomes in medically intractable pressure ulcers.

PURPOSE: Perineal pressure ulcers are a common and devastating complication for paralyzed or chronically bedridden patients. Controversy exists on the benefit of fecal diversion for the treatment and prevention of these ulcers. This study compared outcomes in bed-bound patients with pressure ulcers who electively underwent fecal diversion with those who did not. METHODS: A retrospective review was performed on all disabled patients who underwent surgery for medically intractable pressure ulcer from 1993 to 2001. Charts were divided into the colostomy group or noncolostomy group. Recurrence rates, healing times, morbidity and mortality, and number of reoperations were calculated for each group. Additionally, stoma patients were interviewed for quality of life assessment. RESULTS: Sixty-seven patients were treated during the study period (colostomy, n = 41; noncolostomy, n = 26). The majority of colostomies were performed laparoscopically, with a 9.7 percent incidence of postoperative complications. The ulcer recurrence rate was lower in the treated colostomy group (43 percent) compared with the noncolostomy group (69 percent; P < 0.05). In addition, noncolostomy patients had longer healing times (7 vs. 3 months; P < 0.05), and this group required more ulcer operations than the stoma patients did. Quality of life and bowel care were much improved by the colostomy. CONCLUSIONS: Stoma construction is a safe procedure with low morbidity and mortality that helps heal pressure ulcers and decreases the incidence of recurrence. Additionally, laparoscopic stoma construction represents a technical advance that may reduce operative complications that have been previously reported with open fecal diversion.

Adolescent↗
PubMed2005

Prognostic value of tumor regression evaluated after first course of radiotherapy for anal canal cancer.

PURPOSE: To evaluate whether the tumor response after an initial course of irradiation predicts for colostomy-free survival and overall survival in patients with anal canal cancer. METHODS AND MATERIALS: Between 1980 and 1998, 252 patients were treated by pelvic external-beam radiotherapy (EBRT) followed by a brachytherapy boost in 218 or EBRT in 34. EBRT was combined with chemotherapy in 168 patients. An evaluation of tumor regression, before the boost, was available for 221 patients. They were divided into four groups according to the tumor response: <70%, 70-80%, >80% but <100%, and 100%. RESULTS: The median follow-up time was 58 months. The overall survival rate was 72.6% +/- 3.1% and 57.3% +/- 4.2% at 5 and 10 years, respectively. The disease-free survival rate was 60.0% +/- 3.3% and 49.4% +/- 3.9% at 5 and 10 years, respectively. The colostomy-free survival rate was 61% at 5 years and 47% at 10 years. Two groups could be differentiated according to the percentage of tumor regression before the boost: >80% vs. < or = 80%. The group with a T3-T4 lesion and tumor regression < or = 80% had the poorest overall (52.8% +/- 12.3%), disease-free (19.9% +/- 9.9%), and colostomy-free survival (24.8% +/- 11.2%) rates. CONCLUSION: The amount of tumor regression before EBRT or brachytherapy boost is a strong prognostic factor of disease control without colostomy. When regression is < or = 80% in patients with an initial T3-T4 lesion, the use of conservative RT should be carefully evaluated because of the very poor disease-free and colostomy-free survival.

Aged↗