대한대장항문학회

Patients with rectal carcinomas above the modified Dukes' stage B2 are candidates for<br>the adjuvant postoperative radiotherapy in order to prevent locoregional recurrences. The<br>postoperative radiotherapy with tumoricidal doses, however, frequently contributes to<br>significant incidence of radiation-associated small bowel injury(RASBI) in a dose<br>dependent manner.<br>Author preliminarily reviewed 11 experiences of the use of the greater omentum as a<br>transposition pedicle flap based on the left gastroepiploic artery elevating the small<br>bowel away from the pelvic cavity to maximize the therapeutic ratio of radiation therapy<br>for locoregional control of rectal carcinoma without the fear of RASBI.<br>Totally 11 cancer surgeries(abdominoperineal resection in 8 patients, low anterior<br>resection in 2 patients and posterior pelvic exenteration in 1 patient) were performed in<br>11 patients with rectal carcinomas, and every patient received adjuvant postoperative<br>radiotherapy with the mean dose of 54.0 Gy. The postoperative ileus periods were 3∼7<br>days(mean 4.9 days) and there was no immediate complications related to the<br>flap<br>procedures. With the exception of one patient who showed some inadequate elevation<br>with a segmental descent of the small bowel on the small bowel series and developed<br>RASBI-like clinical findings, there was no documented incidence of clinical RASBI.<br>The safety, effectiveness and ease of this procedufre has allowed to use sufficient<br>tumoricidal doses of the postoperative radiotherapy without the associated harvard of<br>RASBI, which led the author to recommend to use the omental transposition flap for<br>every patient with rectal carcinoma above the modified Dukes' stage B2.<br>