Ann Surg Treat Res.  2019 Sep;97(3):142-148. 10.4174/astr.2019.97.3.142.

Optimal strategies of rectovaginal fistula after rectal cancer surgery

• Woo IT
• Park JS
• Choi GS
• Park SY
• Kim HJ
• Lee HJ

• KMID: 2455975
• DOI: http://doi.org/10.4174/astr.2019.97.3.142

Abstract

PURPOSE
Rectovaginal fistula (RVF) after low anterior resection for rectal cancer is a type of anastomotic leakage. The aim of this study was to find out the difference of leakage, according to RVF presence or absence and to identify the optimal strategy for RVF.
METHODS
All female patients who underwent low anterior resection with colorectal anastomosis or coloanal anastomosis (n = 950) were retrospectively analyzed. Patients' demographics and perioperative outcomes were analyzed between the RVF group and leakage without the RVF (nRVF) group. We performed 4 types of procedures"”primary repair, diverting stoma, redo coloanal anastomosis (RCA), and conservative procedure"”to treat RVF, and calculated the success rates of each type of procedure.
RESULTS
The leakage occurred in 47 patients (4.9%). Among them, 18 patients (1.9%) underwent an RVF and 29 (3.0%) underwent nRVF. The RVF group received more perioperative radiotherapy (27.8% vs. 3.4%, P < 0.015) and occurred late onset after surgery (181.3 ± 176.4 days vs. 23.2 ± 53.6 days, P < 0.001) more than did the nRVF group. In multivariate analysis for the risk factor of the RVF group, the RVF group was statistically associated with less than 5 cm of anastomosis more than was the no-leakage group. A total of 35 procedures were performed in 18 patients with RVF for treatment. RCA showed satisfactory success rates (85.7%, n = 6) and, primary repair (transanal or transvaginal) showed acceptable success rate (33.3%, n = 8).
CONCLUSION
After low anterior resection for rectal cancer, RVF was strongly correlated with a lower level of primary tumor location. Among the patients who underwent leakages, receipt of perioperative radiotherapy was significantly high in the RVF group than that of the nRVF group. Additionally, this study suggests that RCA might be considered another successful treatment strategy for RVF.

Keyword

Anastomotic leakage; Colectomy; Rectal neoplasms; Rectovaginal fistula

MeSH Terms

Anastomotic Leak
Colectomy
Demography
Female
Humans
Multivariate Analysis
Radiotherapy
Rectal Neoplasms*
Rectovaginal Fistula*
Retrospective Studies
Risk Factors

Figure

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  Fig. 1 Flowchart to obtain the result of a curative resection with colorectal or coloanal anastomosis for rectal cancer patients. RVF, leakage with rectovaginal fistula; nRVF, leakage without rectovaginal fistula.

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