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Optimal strategies of rectovaginal fistula after rectal cancer surgery

Annals of Surgical Treatment and Research 2019년 97권 3호 p.142 ~ 148
 ( Woo In-Teak ) - Soonchunhyang University Gumi Hospital Department of Surgery

 ( Park Jun-Seok ) - Kyungpook National University School of Medicine Kyungpook National University Medical Center Colorectal Cancer Center
 ( Choi Gyu-Seog ) - Kyungpook National University School of Medicine Kyungpook National University Medical Center Colorectal Cancer Center
 ( Park Soo-Yeun ) - Kyungpook National University School of Medicine Kyungpook National University Medical Center Colorectal Cancer Center
 ( Kim Hye-Jin ) - Kyungpook National University School of Medicine Kyungpook National University Medical Center Colorectal Cancer Center
 ( Lee Hee-Jae ) - Fatima Hospital

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.

키워드

Anastomotic leakage; Colectomy; Rectal neoplasms; Rectovaginal fistula
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