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A nomogram for predicting rectovaginal fistula after low anterior resection for rectal cancer

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Abstract

Purpose

Rectovaginal fistula (RVF) is a complicated and troublesome complication of low anterior resection (LAR) for rectal cancer. We aimed to investigate the risk factors for post-LAR RVF and develop a predictive nomogram.

Methods

We performed a retrospective analysis of 821 female patients with rectal cancer who underwent LAR between October 2010 and October 2018. Logistic regression was performed to identify risk factors. A nomogram was developed to predict RVF.

Results

The incidence of post-LAR RVF was 3.4% (28/821). A multivariate analysis showed that the preoperative serum hemoglobin level (OR 2.449, 95% CI 1.144–5.239), the distance between the tumor and anal verge (OR 4.158, 95% CI 1.392–12.418), surgical procedure (OR 2.369, 95% CI 1.117–5.027), hysterectomy (OR 2.996, 95% CI 1.106–8.833), and bilateral oophorectomy (OR 5.823, 95% CI 1.639–20.689) were significantly associated with the development of RVF. A nomogram was developed, which showed a C-index of 0.824 (95% CI 0.730–0.918) and an adjusted C-index of 0.790.

Conclusion

This study identified the preoperative serum hemoglobin level, the distance between the tumor and the anal verge, the type of surgical procedure, hysterectomy, and bilateral oophorectomy as predictors of post-LAR RVF. A nomogram was successfully developed. It could aid in the prediction of RVF in patients undergoing LAR.

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Acknowledgements

This study was financially supported by the National Clinical Key Specialty Construction Project (General Surgery) of China (No. 2012-649), and Natural Science Foundation of Fujian Province (2016J01456).

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Author notes

  1. Ming-Jin Huang, Dao-Xiong Ye and Yu Lin contributed equally to this work and share therefore first authorship.

Authors and Affiliations

  1. Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, 350001, Fujian, People’s Republic of China

    Ming-Jin Huang, Dao-Xiong Ye, Yu Lin, Xing-Rong Lu, Hui-Ming Lin, Pan Chi & Ying Huang

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  1. Ming-Jin Huang
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  2. Dao-Xiong Ye
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  3. Yu Lin
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  7. Ying Huang
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Contributions

MH, DY and YL conceived of the study, performed the data analysis and prepared the manuscript draft. YH, PC, HL and XL revised the manuscript critically for important intellectual content. MH, DY and YL performed data collection and designed the study; all authors read and approved the final manuscript.

Corresponding authors

Correspondence to Pan Chi or Ying Huang.

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The authors declare no conflicts of interest in association with the present study.

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Huang, MJ., Ye, DX., Lin, Y. et al. A nomogram for predicting rectovaginal fistula after low anterior resection for rectal cancer. Surg Today 50, 1206–1212 (2020). https://doi.org/10.1007/s00595-020-02049-9

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  • DOI: https://doi.org/10.1007/s00595-020-02049-9

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