Incidence and risk factors for rectovaginal fistula after low anterior resection for rectal cancer
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The rectovaginal fistula (RVF) is a rare complication after low anterior resection (LAR) for rectal cancer. The aim of this study was to evaluate the risk factors for RVF after LAR for rectal cancer.
This was a retrospective multi-institution study of 371 female rectal cancer patients who underwent LAR with anastomosis between January 2007 and December 2011. Patient-, tumor-, and surgery-related variables were examined by univariate and multivariate analyses.
The overall RVF rate was 3.0 % (11/371). The RVF was diagnosed on median postoperative day 83 (15–766). In 81.8 % (9/11) of the patients, the diagnosis of RVF was made after hospital discharge. Multivariate analysis identified prognostic nutritional index (PNI; odds ratio (OR) 6.97; 95 % confidence interval (CI) 1.47–33.08; P = 0.015), preoperative chemotherapy (OR 27.31; CI 3.49–213.62; P = 0.002), tumor size (OR 5.90; CI 1.04–33.47; P = 0.045), intraoperative bleeding (OR 13.91; CI 1.34–144.42; P = 0.027), and lateral lymph node dissection (OR 4.92; CI 1.02–23.63; P = 0.045) as independent risk factors for RVF after LAR.
Risk factors of RVF were PNI (<45), preoperative chemotherapy, tumor size (≧50 mm), intraoperative bleeding (≧200 ml), and lateral lymph node dissection. Before an operation, obtaining the information about these risk factors is of great importance in LAR for rectal cancer.
KeywordsRectovaginal fistula Rectal cancer Anastomotic-vaginal fistula Anastomotic leakage Low anterior resection
Conflict of interest
Jun Watanabe, Mitsuyoshi Ota, Daisuke Kawaguchi, Hidetaka Shima, Shuhei Kaida, Shunichi Osada, Nobuyuki Kamimukai, Noriyuki Kamiya, Atsushi Ishibe, Kazuteru Watanabe, Ryusei Matsuyama, Hirotoshi Akiyama, Yasushi Ichikawa, Mari Oba, and Itaru Endo have no conflicts of interest or financial ties to disclose.
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