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International Journal of Colorectal Disease

, Volume 30, Issue 12, pp 1659–1666 | Cite as

Incidence and risk factors for rectovaginal fistula after low anterior resection for rectal cancer

  • 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
  • Itaru Endo
Original Article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Rectovaginal fistula Rectal cancer Anastomotic-vaginal fistula Anastomotic leakage Low anterior resection 

Notes

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.

References

  1. 1.
    Bangser M (2006) Obstetric fistula and stigma. Lancet 367(9509):535–536CrossRefPubMedGoogle Scholar
  2. 2.
    Cook RJ, Dickens BM, Syed S (2004) Obstetric fistula: the challenge to human rights. Int J Gynaecol Obstet 87(1):72–77CrossRefPubMedGoogle Scholar
  3. 3.
    Hotouras A, Ribas Y, Zakeri S, Murphy J, Bhan C, Chan C (2014) Gracilis muscle interposition for rectovaginal and anovaginal fistula repair: a systematic literature review. Color Dis Off J Assoc Coloproctol Great Brit Irel 5(10):12791. doi: 10.1111/codi.12791 Google Scholar
  4. 4.
    Tozer PJ, Balmforth D, Kayani B, Rahbour G, Hart AL, Phillips RK (2013) Surgical management of rectovaginal fistula in a tertiary referral centre: many techniques are needed. Color Dis Off J Assoc Coloproctol Great Brit Irel 15(7):871–877CrossRefGoogle Scholar
  5. 5.
    Pata G, Pasini M, Roncali S, Tognali D, Ragni F (2014) Iatrogenic rectovaginal fistula repair by trans-perineal approach and pubo-coccygeus muscle interposition. Int J Surg Case Rep 5(8):527–531PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Kin C, Gurland B, Zutshi M, Hull T (2012) Martius flap repair for complex rectovaginal fistula. Pol Przegl Chir 84(11):601–604PubMedGoogle Scholar
  7. 7.
    Rex JC Jr, Khubchandani IT (1992) Rectovaginal fistula: complication of low anterior resection. Dis Colon Rectum 35(4):354–356CrossRefPubMedGoogle Scholar
  8. 8.
    Kosugi C, Saito N, Kimata Y, Ono M, Sugito M, Ito M, Sato K, Koda K, Miyazaki M (2005) Rectovaginal fistulas after rectal cancer surgery: incidence and operative repair by gluteal-fold flap repair. Surgery 137(3):329–336CrossRefPubMedGoogle Scholar
  9. 9.
    van Onkelen RS, Gosselink MP, Thijsse S, Schouten WR (2014) Predictors of outcome after transanal advancement flap repair for high transsphincteric fistulas. Dis Colon Rectum 57(8):1007–1011CrossRefPubMedGoogle Scholar
  10. 10.
    Gottgens KW, Smeets RR, Stassen LP, Beets G, Breukink SO (2014) The disappointing quality of published studies on operative techniques for rectovaginal fistulas: a blueprint for a prospective multi-institutional study. Dis Colon Rectum 57(7):888–898CrossRefPubMedGoogle Scholar
  11. 11.
    Antonsen HK, Kronborg O (1987) Early complications after low anterior resection for rectal cancer using the EEA stapling device. A prospective trial. Dis Colon Rectum 30(8):579–583CrossRefPubMedGoogle Scholar
  12. 12.
    Arbman G (1993) Rectovaginal fistulas and the double-stapling technique. Dis Colon Rectum 36(3):310–311CrossRefPubMedGoogle Scholar
  13. 13.
    Baran JJ, Goldstein SD, Resnik AM (1992) The double-staple technique in colorectal anastomoses: a critical review. Am Surg 58(4):270–272PubMedGoogle Scholar
  14. 14.
    Fleshner PR, Schoetz DJ Jr, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC (1992) Anastomotic-vaginal fistula after colorectal surgery. Dis Colon Rectum 35(10):938–943CrossRefPubMedGoogle Scholar
  15. 15.
    Nakagoe T, Sawai T, Tuji T, Nanashima A, Yamaguchi H, Yasutake T, Ayabe H (1999) Avoidance of rectovaginal fistula as a complication after low anterior resection for rectal cancer using a double-stapling technique. J Surg Oncol 71(3):196–197CrossRefPubMedGoogle Scholar
  16. 16.
    Sugarbaker PH (1996) Rectovaginal fistula following low circular stapled anastomosis in women with rectal cancer. J Surg Oncol 61(2):155–158. doi: 10.1002/(SICI)1096-9098(199602)61:2<155::AID-JSO12>3.0.CO;2-8 CrossRefPubMedGoogle Scholar
  17. 17.
    Tsutsumi N, Yoshida Y, Maehara Y, Kohnoe S (2007) Rectovaginal fistula following double-stapling anastomosis in low anterior resection for rectal cancer. Hepatogastroenterology 54(78):1682–1683PubMedGoogle Scholar
  18. 18.
    Matthiessen P, Hansson L, Sjodahl R, Rutegard J (2010) Anastomotic-vaginal fistula (AVF) after anterior resection of the rectum for cancer--occurrence and risk factors. Color Dis Off J Assoc Coloproctol Great Brit Irel 12(4):351–357CrossRefGoogle Scholar
  19. 19.
    Sobin LH GM, Wittekind C (2009) TNM classification of malignant tumours, 7th edn. Wiley-Blackwell. NovemberGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Jun Watanabe
    • 1
  • Mitsuyoshi Ota
    • 2
  • Daisuke Kawaguchi
    • 3
  • Hidetaka Shima
    • 4
  • Shuhei Kaida
    • 1
  • Shunichi Osada
    • 5
  • Nobuyuki Kamimukai
    • 6
  • Noriyuki Kamiya
    • 7
  • Atsushi Ishibe
    • 8
  • Kazuteru Watanabe
    • 9
  • Ryusei Matsuyama
    • 8
  • Hirotoshi Akiyama
    • 8
  • Yasushi Ichikawa
    • 8
  • Mari Oba
    • 10
  • Itaru Endo
    • 8
  1. 1.Department of SurgeryYokosuka Kyosai HospitalYokosukaJapan
  2. 2.Department of Surgery, Gastroenterological CenterYokohama City UniversityYokohamaJapan
  3. 3.Department of SurgeryYokohama Municipal Citizen’s HospitalYokohamaJapan
  4. 4.Department of SurgeryYokosuka Municipal Citizen’s HospitalYokosukaJapan
  5. 5.Department of SurgeryYokohama City Minato Red Cross HospitalYokohamaJapan
  6. 6.Department of SurgeryYokohama Hodogaya Central HospitalYokohamaJapan
  7. 7.Department of SurgeryIto Municipal HospitalItoJapan
  8. 8.Department of Gastroenterological SurgeryYokohama City University Graduate School of MedicineYokohamaJapan
  9. 9.Department of SurgeryNTT Medical CenterTokyoJapan
  10. 10.Department of Biostatistics and EpidemiologyYokohama City UniversityYokohamaJapan

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