Colostomy is a simple and effective procedure for severe chronic radiation proctitis

Table 1 Modified subjective objective management analysis system to assess the severity of bleeding in radiation proctitis

Grade	Bleeding	Severity	Anemia (Hb, g/L)
1	Mild bleeding	Occasionally or occult	Mild anemia (Hb: ≥ 90 g/L)
2	Moderate bleeding	Persistent	Moderate anemia (Hb: 70-90 g/L)
3	Severe bleeding	Gross	Severe anemia, transfusion needed (Hb: < 70 g/L)

Hb: Hemoglobin.

Table 2 Comparisons of patient demographics between the colostomy group and conservative group before treatment n (%)

Characteristics	Diverting colostomy (n = 22)	Conservative treatment (n = 25)	P value
Age (mean ± SD)	60.1 ± 2.2	60.2 ± 2.4	0.964
Gender (female/male)	20/2	23/2	1.0001
Primary malignancy			0.8222
Cervical cancer	19 (86.4)	21 (84)
Endometrial cancer	2 (9.1)	2 (8)
Rectal cancer	1 (4.5)	1 (4)
Prostate cancer	0 (0)	1 (4)
Cumulative radiation dosage (Gy), mean ± SD	80.5 ± 17.3	83.6 ± 20.5	0.8423
Latency period (mo), mean ± SD	8.3 ± 0.8	7.2 ± 1.1	0.2523
Duration from treatment to end of radiotherapy (mo), mean ± SD	16.3 ± 1.3	14.8 ± 1.6	0.2773
Duration of bleeding (month), mean ± SD	7.9 ± 1.0	8.0 ± 1.8	0.4661
Score of bleeding, mean ± SD	2.7 ± 0.5	2.0 ± 0.5	< 0.0013
Mean hemoglobin (g/L), mean ± SD	60.8 ± 18.1	88.2 ± 19.3	< 0.001
Alb (g/L), ( ≤ 35/> 35)	6/16	3/22	0.3391
BMI (kg/m2), ( ≤ 17.5/> 17.5)	3/19	2/23	0.8801
Concomitant radiation uropathy	8 (36.4)	6 (24)	0.355
Radiation enteritis	5 (22.7)	2 (8)	0.3151
Previous abdominal surgery	6 (27.3)	11 (44)	0.234
Diabetes mellitus	2 (9.1)	3 (12)	1.0001
Hypertension	6 (27.3)	7 (28)	0.956

¹χ² test;

²Fisher exact test;

³Wilcoxon rank-sum test. BMI: Body mass index; Alb: Albumin.

Table 3 Bleeding remissions in severe radiation proctitis after treatment

Variables	Diverting Colostomy (n = 22)	Conservative treatment (n = 25)	P value
6 mo after treatment
Remission of bleeding	17/18 (94%)	3/25 (12%)	< 0.0011
Remission of refractory perianal pain	8/8 (100%)	0/6 (0%)	< 0.0012
Score of bleeding, mean ± SD	1.1 ± 0.5	2.2 ± 0.7	< 0.0013
Elevated Hb, mean ± SD	34.1 ± 18.2	-12.3 ± 9.14	< 0.001
Remission of moderate bleeding	8/8 (100%)	6/19 (21.5%)	0.0022
Remission of severe bleeding	11/11 (100%)	0/5 (0)	< 0.0012
Score of bleeding, mean ± SD	0.8 ± 0.5	2.0 ± 0.9	< 0.0013
Post-treatment recto-vaginal fistula	0/22	3/25 (12%)	0.2372
Elevated Hb, mean ± SD	40.3 ± 19.3	-1.9 ± 32.54	0.003

¹χ² test;

²Fisher exact test;

³Wilcoxon rank-sum test;

⁴Represents decreased level.

Table 4 Quality of life between diversion group and conservative group in CRP patients by EORTC QLQ-C30 scale

QLQ-C30 scale	Ref. (Normal German population)	Diverting colostomy group (n = 18), mean (SD)				Conservative treatment group (n = 23), mean (SD)
		Pre-treatment	Follow-up	Δ(FU)-Pre1	Significance2	Pre-treatment	Follow-up	Δ(FU)-Pre	Significance2
Global health	63.2	23.1 (15.1)	64.8 (13.8)	41.7	< 0.001	47.1 (21.5)	62.3 (25.0)	15.2	0.033
Physical function	82.6	50.7 (17.8)	77.8 (16.6)	27.1	< 0.001	78.0 (22.7)	78.6 (26.1)	0.6	0.856
Role function	75.0	34.3 (23.9)	75.9 (27.3)	41.6	< 0.001	77.5 (24.9)	77.5 (29.1)	0.0	0.775
Emotional function	62.2	46.3 (27.4)	73.6 (27.0)	27.3	0.001	75.7 (17.6)	80.8 (23.8)	5.1	0.384
Cognition function	81.3	92.6 (12.7)	93.5 (9.8)	0.9	0.581	94.2 (15.6)	95.7 (9.0)	1.5	0.798
Social function	78.4	43.5 (28.9)	65.7 (31.7)	22.2	0.004	91.3 (20.6)	89.1 (21.1)	-2.2	0.916
Fatigue	34.1	72.8 (12.9)	36.4 (25.9)	-36.4	< 0.001	26.6 (24.1)	23.2 (27.2)	-3.4	0.695
Nausea/vomiting	5.7	4.6 (15.5)	1.9 (7.6)	-2.7	0.109	5.1 (15.4)	6.5 (16.5)	1.4	0.655
Pain	33.1	44.4 (28.3)	14.8 (22.8)	-29.6	0.001	14.5 (21.5)	11.6 (18.4)	-2.9	0.481
Dyspnea	18.8	42.6 (31.0)	18.5 (22.8)	-24.1	0.003	14.5 (19.7)	8.7 (18.0)	-5.8	0.210
Insomnia	38.5	48.1 (35.5)	29.6 (31.2)	-18.5	0.026	21.7 (21.6)	26.1 (31.7)	4.4	0.287
Appetite loss	9.4	22.2 (27.2)	13.0 (19.7)	-9.2	0.125	10.1 (25.5)	8.7 (18.0)	-1.4	0.785
Constipation	9.1	9.3 (14.9)	3.7 (10.5)	-5.6	0.066	8.7 (20.6)	7.2 (22.4)	-1.5	0.414
Diarrhea	9.2	33.3 (33.3)	22.2 (24.8)	-11.1	0.018	11.6 (23.8)	2.9 (9.6)	-8.7	0.078
Financial difficulties	17.1	59.3 (26.2)	50.0 (31.9)	-9.3	0.211	26.1 (31.7)	24.6 (30.5)	-1.5	0.595

¹Wilcoxon rank-sum test;

²Point (follow-up) - point (pre-treatment).