Novel use of an air-filled breast prosthesis to allow radiotherapy to recurrent colonic cancer.

Hdl Handle:
http://hdl.handle.net/10147/207162
Title:
Novel use of an air-filled breast prosthesis to allow radiotherapy to recurrent colonic cancer.
Authors:
O'Duffy, F; Toomey, D P; Fleming, F; McNamara, D A
Affiliation:
Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland., fergaloduffy@hotmail.com
Citation:
Colorectal Dis. 2011 Mar;13(3):e42-5. doi: 10.1111/j.1463-1318.2010.02476.x.
Journal:
Colorectal disease : the official journal of the Association of Coloproctology of, Great Britain and Ireland
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207162
DOI:
10.1111/j.1463-1318.2010.02476.x
PubMed ID:
21320268
Abstract:
AiM: The authors present the novel and successful use of an air-filled breast prosthesis for extra pelvic exclusion of small bowel to facilitate adjuvant radiotherapy following resection of recurrent adenocarcinoma of the ascending bowel. The therapeutic use of radiotherapy in colon cancer can cause acute or chronic radiation enteropathy. Mobile small bowel can be sequestered in 'dead space' or by adhesions exposing it to adjuvant radiotherapy. A variety of pelvic partitioning methods have been described to exclude bowel from radiation fields using both native and prosthetic materials. METHOD: In this case a 68 year old presented with ascending colon adenocarcinoma invading the peritoneum and underwent en bloc peritoneal resection. Thirty-seven months later surveillance CT identified a local recurrence. Subsequent resection resulted in a large iliacus muscle defect which would sequester small bowel loops thus exposing the patient to radiation enteropathy. The lateral position of the defect precluded the use of traditional pelvic partitioning methods which would be unlikely to remain in place long enough to allow radiotherapy. A lightweight air-filled breast prosthesis (Allergan 133 FV 750 cms) secured in place with an omentoplasty was used to fill the defect. RESULTS: Following well tolerated radiotherapy the prosthesis was deflated under ultrasound guidance and removed via a 7-cm transverse incision above the right iliac crest. The patient is disease free 18 months later with no evidence of treatment related morbidity. CONCLUSION: The use of a malleable air-filled prosthesis for pelvic partitioning allows specific tailoring of the prosthesis size and shape for individual patient defects. It is also lightweight enough to be secured in place using an omentoplasty to prevent movement related prosthesis migration. In the absence of adequate omentum a mesh sling may be considered to allow fixation. In this case the anatomy of the prosthesis position allowed for its removal without the need for repeat laparotomy. Pre-operative deflation of the air-filled prosthesis under ultrasound guidance also reduces the size of the incision required for removal. This technique may be valuable to prevent collateral small bowel irradiation following resection of renal or retroperitoneal malignancy.
Language:
eng
MeSH:
Adenocarcinoma/*radiotherapy/surgery; Aged; Breast Implants; Colon, Ascending/pathology/surgery; Colonic Neoplasms/*radiotherapy/surgery; Combined Modality Therapy; Female; Humans; Intestine, Small/anatomy & histology/*radiation effects; Neoplasm Recurrence, Local/*radiotherapy/surgery; Prosthesis Implantation/adverse effects/methods; Radiation Injuries/*prevention & control; Radiation Protection/*instrumentation; Radiotherapy, Adjuvant/adverse effects/*methods
ISSN:
1463-1318 (Electronic); 1462-8910 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorO'Duffy, Fen_GB
dc.contributor.authorToomey, D Pen_GB
dc.contributor.authorFleming, Fen_GB
dc.contributor.authorMcNamara, D Aen_GB
dc.date.accessioned2012-02-01T10:00:46Z-
dc.date.available2012-02-01T10:00:46Z-
dc.date.issued2012-02-01T10:00:46Z-
dc.identifier.citationColorectal Dis. 2011 Mar;13(3):e42-5. doi: 10.1111/j.1463-1318.2010.02476.x.en_GB
dc.identifier.issn1463-1318 (Electronic)en_GB
dc.identifier.issn1462-8910 (Linking)en_GB
dc.identifier.pmid21320268en_GB
dc.identifier.doi10.1111/j.1463-1318.2010.02476.xen_GB
dc.identifier.urihttp://hdl.handle.net/10147/207162-
dc.description.abstractAiM: The authors present the novel and successful use of an air-filled breast prosthesis for extra pelvic exclusion of small bowel to facilitate adjuvant radiotherapy following resection of recurrent adenocarcinoma of the ascending bowel. The therapeutic use of radiotherapy in colon cancer can cause acute or chronic radiation enteropathy. Mobile small bowel can be sequestered in 'dead space' or by adhesions exposing it to adjuvant radiotherapy. A variety of pelvic partitioning methods have been described to exclude bowel from radiation fields using both native and prosthetic materials. METHOD: In this case a 68 year old presented with ascending colon adenocarcinoma invading the peritoneum and underwent en bloc peritoneal resection. Thirty-seven months later surveillance CT identified a local recurrence. Subsequent resection resulted in a large iliacus muscle defect which would sequester small bowel loops thus exposing the patient to radiation enteropathy. The lateral position of the defect precluded the use of traditional pelvic partitioning methods which would be unlikely to remain in place long enough to allow radiotherapy. A lightweight air-filled breast prosthesis (Allergan 133 FV 750 cms) secured in place with an omentoplasty was used to fill the defect. RESULTS: Following well tolerated radiotherapy the prosthesis was deflated under ultrasound guidance and removed via a 7-cm transverse incision above the right iliac crest. The patient is disease free 18 months later with no evidence of treatment related morbidity. CONCLUSION: The use of a malleable air-filled prosthesis for pelvic partitioning allows specific tailoring of the prosthesis size and shape for individual patient defects. It is also lightweight enough to be secured in place using an omentoplasty to prevent movement related prosthesis migration. In the absence of adequate omentum a mesh sling may be considered to allow fixation. In this case the anatomy of the prosthesis position allowed for its removal without the need for repeat laparotomy. Pre-operative deflation of the air-filled prosthesis under ultrasound guidance also reduces the size of the incision required for removal. This technique may be valuable to prevent collateral small bowel irradiation following resection of renal or retroperitoneal malignancy.en_GB
dc.language.isoengen_GB
dc.subject.meshAdenocarcinoma/*radiotherapy/surgeryen_GB
dc.subject.meshAgeden_GB
dc.subject.meshBreast Implantsen_GB
dc.subject.meshColon, Ascending/pathology/surgeryen_GB
dc.subject.meshColonic Neoplasms/*radiotherapy/surgeryen_GB
dc.subject.meshCombined Modality Therapyen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshIntestine, Small/anatomy & histology/*radiation effectsen_GB
dc.subject.meshNeoplasm Recurrence, Local/*radiotherapy/surgeryen_GB
dc.subject.meshProsthesis Implantation/adverse effects/methodsen_GB
dc.subject.meshRadiation Injuries/*prevention & controlen_GB
dc.subject.meshRadiation Protection/*instrumentationen_GB
dc.subject.meshRadiotherapy, Adjuvant/adverse effects/*methodsen_GB
dc.titleNovel use of an air-filled breast prosthesis to allow radiotherapy to recurrent colonic cancer.en_GB
dc.contributor.departmentDepartment of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland., fergaloduffy@hotmail.comen_GB
dc.identifier.journalColorectal disease : the official journal of the Association of Coloproctology of, Great Britain and Irelanden_GB
dc.description.provinceLeinster-

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