Fico V, Altieri G, Di Grezia M, Bianchi V, Chiarello MM, Pepe G, Tropeano G, Brisinda G. Surgical complications of oncological treatments: A narrative review. World J Gastrointest Surg 2023; 15(6): 1056-1067 [PMID: 37405101 DOI: 10.4240/wjgs.v15.i6.1056]
Corresponding Author of This Article
Giuseppe Brisinda, MD, Professor, Surgeon, Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, 8 Largo Agostino Gemelli, Rome 00168, Italy. gbrisin@tin.it
Research Domain of This Article
Surgery
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jun 27, 2023; 15(6): 1056-1067 Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1056
Surgical complications of oncological treatments: A narrative review
Valeria Fico, Gaia Altieri, Marta Di Grezia, Valentina Bianchi, Maria Michela Chiarello, Gilda Pepe, Giuseppe Tropeano, Giuseppe Brisinda
Valeria Fico, Gaia Altieri, Marta Di Grezia, Valentina Bianchi, Gilda Pepe, Giuseppe Tropeano, Giuseppe Brisinda, Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
Maria Michela Chiarello, Department of Surgery, Azienda Sanitaria Provinciale di Cosenza, Cosenza 87100, Italy
Giuseppe Brisinda, Department of Medicine and Surgery, Catholic School of Medicine, Rome 00168, Italy
Author contributions: Fico V and Altieri GM equally contributed to the drafting of the manuscript; Fico V, Altieri G, Tropeano G, Di Grezia M, Bianchi V, Chiarello MM, and Brisinda G designed the research; Bianchi V, Pepe G, Fico V, and Altieri G performed the research; Fico V, Altieri G, Tropeano G, and Di Grezia M analyzed the data; Fico V, Altieri G, Pepe G, and Brisinda G wrote the paper; all the authors read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Giuseppe Brisinda, MD, Professor, Surgeon, Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, 8 Largo Agostino Gemelli, Rome 00168, Italy. gbrisin@tin.it
Received: January 16, 2023 Peer-review started: January 16, 2023 First decision: January 31, 2023 Revised: February 3, 2023 Accepted: April 17, 2023 Article in press: April 17, 2023 Published online: June 27, 2023 Processing time: 149 Days and 20.7 Hours
Abstract
Gastrointestinal complications are common in patients undergoing various forms of cancer treatments, including chemotherapy, radiation therapy, and molecular-targeted therapies. Surgical complications of oncologic therapies can occur in the upper gastrointestinal tract, small bowel, colon, and rectum. The mechanisms of action of these therapies are different. Chemotherapy includes cytotoxic drugs, which block the activity of cancer cells by targeting intracellular DNA, RNA, or proteins. Gastrointestinal symptoms are very common during chemotherapy, due to a direct effect on the intestinal mucosa resulting in edema, inflammation, ulceration, and stricture. Serious adverse events have been described as complications of molecular targeted therapies, including bowel perforation, bleeding, and pneumatosis intestinalis, which may require surgical evaluation. Radiotherapy is a local anti-cancer therapy, which uses ionizing radiation to cause inhibition of cell division and ultimately lead to cell death. Complications related to radiotherapy can be both acute and chronic. Ablative therapies, including radiofrequency, laser, microwave, cryoablation, and chemical ablation with acetic acid or ethanol, can cause thermal or chemical injuries to the nearby structures. Treatment of the different gastrointestinal complications should be tailored to the individual patient and based on the underlying pathophysiology of the complication. Furthermore, it is important to know the stage and prognosis of the disease, and a multidisciplinary approach is necessary to personalize the surgical treatment. The purpose of this narrative review is to describe complications related to different oncologic therapies that may require surgical interventions.
Core Tip: Gastrointestinal complications are common in patients undergoing various forms of cancer treatments, including chemotherapy, radiation therapy, and molecular-targeted therapies. Surgical complications of oncologic therapies can occur in the upper gastrointestinal tract, small bowel, colon, and rectum. Treatment of the different gastrointestinal complications should be tailored to the individual patient and based on the underlying pathophysiology of the complication.
