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

Watanabe, Jun; Ota, Mitsuyoshi; Kawaguchi, Daisuke; Shima, Hidetaka; Kaida, Shuhei; Osada, Shunichi; Kamimukai, Nobuyuki; Kamiya, Noriyuki; Ishibe, Atsushi; Watanabe, Kazuteru; Matsuyama, Ryusei; Akiyama, Hirotoshi; Ichikawa, Yasushi; Oba, Mari; Endo, Itaru

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.