Rectovaginal fistula after low anterior resection in Chinese patients with colorectal cancer

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// Hongtu Zheng 1, 2, * , Tianan Guo 2, * , Yuchen Wu 2 , Cong Li 1, 2 , Sanjun Cai 1, 2 , Fangqi Liu 1, 2 and Ye Xu 1, 2 1 Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China * These authors contributed equally to this work Correspondence to: Ye Xu, email: xu_shirley021@163.com , xuye021@163.com Fangqi Liu, email: 12131230023@fudan.edu.cn Keywords: rectovaginal fistula, low anterior resection Received: January 26, 2017 Accepted: March 27, 2017 Published: April 11, 2017 ABSTRACT Rectovaginal fistula is a postoperative complication of low anterior resection. We investigated the incidence of rectovaginal fistula (RVF) after low anterior resection, its risk factors and its optimal treatment. We analyzed data from 1,493 female patients who underwent low anterior resection for colorectal cancer between January 2006 and March 2016. We calculated the incidence of RVF and performed univariate and multivariate logistic regression analyses to identify risk factors. Twenty-four patients experienced RVF, giving an incidence of 1.61%. Univariate analysis revealed a short distance between the tumor and the anal verge ( p < 0.001), longer surgery duration ( p = 0.009), unsatisfactory anastomosis ( p < 0.001), and greater intraoperative blood loss ( p = 0.002) to be risk factors for RVF. Multivariate analysis showed that only distance between the tumor and the anal verge and unsatisfactory anastomosis were risk factors for RVF. Sixteen patients (66.7%) healed within a range of 30-1,225 days (median, 210 days). Twenty-one patients underwent surgery for diverting stoma; of those, 15 of them (71.4%) recovering after ostomy. These results indicate the primary risk factors for RVF are unsatisfactory anastomosis and short distance between the tumor and the anal verge. Most cases of RVF can be healed using a diverting stoma alone, without the need for additional surgery.