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- Title
Radiation-induced rectovaginal fistulas in locally advanced gynaecological malignancies-new patients, old problem?
- Authors
Zelga, Piotr; Tchórzewski, Marcin; Zelga, Marta; Sobotkowski, Janusz; Dziki, Adam
- Abstract
Purpose: Radiation-induced rectovaginal fistula (RI-RVF) is a chronic and serious condition with a significant influence on quality of life. The aim of this study is to evaluate the results of surgical treatment of rectovaginal fistulas of patients previously undergoing radiotherapy. Methods: Fifty patients treated in the Gynaecological Radiotherapy Unit for gynaecologic malignancy and in the Department of General and Colorectal Surgery for RI-RVF between 2003 and 2013 were enrolled into a prospectively maintained database and underwent regular follow-up examinations in an outpatient clinic, during which surgical outcomes were assessed. Results: Median age was 60 years (range 40-84 years). Cervical cancer was the most common cause of radiotherapy. Median time of fistula development after radiotherapy was 20 months (range 5-240 months). In 48 (96%) patients, only faecal diversion could be performed, while two patients underwent rectal resection. The fistula healed in six patients. Factors that correlated with fistula healing were a distance from the anal verge above 7 cm ( p = 0.007 OR 18 95%CI 2.2609-14.3062) and creation of loop ileostomy ( p = 0.08 OR 17 95%CI 1.2818-23.9701), whereas a prolonged course of radiotherapy of more than 6 weeks ( p = 0.047) correlated negatively. In multivariate analysis, only distance from the anal verge remained significant ( p = 0.031 OR 2.35 95%CI 1.0422-5.2924). Conclusions: The treatment of radiation-induced rectovaginal fistulas needs to be tailored individually to each patient. Faecal diversion remains the simplest and safest method of treating RI-RVF, especially in the group of patients who cannot undergo complicated surgical procedures, and offers acceptable quality of life.
- Subjects
RECTOVAGINAL fistula; PHYSIOLOGICAL effects of radiation; GYNECOLOGIC errors; HEALTH status indicators; PROCTOLOGY
- Publication
Langenbeck's Archives of Surgery, 2017, Vol 402, Issue 7, p1079
- ISSN
1435-2443
- Publication type
Article
- DOI
10.1007/s00423-016-1539-4