Prevention of radiation enteritis by an absorbable polyglycolic acid mesh sling: a 60-case multicentric study

Radiation is often used in conjunction with surgery in the treatment of cancer. When the primary cancer is removed, radiation is applied to the region of the malignancy to destroy any tiny nests of tumor cells that may have escaped detection and removal. Invariably, the dose of radiation is limited by the damage that might be inflicted upon normal, health tissues. This is especially true in the treatment of cancer in the pelvic region. The small intestines are particularly susceptible to the deleterious effects of radiation. When the dose of radiation exceeds 4,000 to 5,000 cGy, small intestine damage occurs in 5 to 25 percent of cases. This dose range of radiation is not small, but is significantly smaller than that given for many tumors, and is smaller than would be preferred for best results. One way of reducing the risk of radiation damage to the small intestine would be to hoist it out of the way, so that it is no longer in the direct path of the radiation beam. This would require the surgical placement of a sling within the patient's abdomen to hold the small intestine. Furthermore, a second surgical procedure would be necessary to remove the sling after radiotherapy is complete. Researchers have now simplified this procedure by developing a sling composed of an absorbable material. This avoids a second surgical procedure by eliminating the requirement for removing the sling. An absorbable mesh sling composed of polyglycolic acid was tested in the treatment of 60 cancer patients requiring irradiation of the pelvic region. Surgical complications occurred in five patients, and four developed radiation-induced inflammation of the bowels despite the preventive measure. Magnetic resonance imaging was used to observe the resorption of the mesh material, which was complete three to five months after the operation. The results suggest that the polyglycolic acid mesh sling is safe, and should be considered for patients at high risk for the recurrence of pelvic cancer who may benefit from increased doses of radiation therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)