Jun Watanabe1, Mitsuyoshi Ota2, Daisuke Kawaguchi3, Hidetaka Shima4, Shuhei Kaida5, Shunichi Osada6, Nobuyuki Kamimukai7, Noriyuki Kamiya8, Atsushi Ishibe9, Kazuteru Watanabe10, Ryusei Matsuyama9, Hirotoshi Akiyama9, Yasushi Ichikawa9, Mari Oba11, Itaru Endo9. 1. Department of Surgery, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka, 238-8558, Japan. nabe-jun@comet.ocn.ne.jp. 2. Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan. 3. Department of Surgery, Yokohama Municipal Citizen's Hospital, Yokohama, Japan. 4. Department of Surgery, Yokosuka Municipal Citizen's Hospital, Yokosuka, Japan. 5. Department of Surgery, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka, 238-8558, Japan. 6. Department of Surgery, Yokohama City Minato Red Cross Hospital, Yokohama, Japan. 7. Department of Surgery, Yokohama Hodogaya Central Hospital, Yokohama, Japan. 8. Department of Surgery, Ito Municipal Hospital, Ito, Japan. 9. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan. 10. Department of Surgery, NTT Medical Center, Tokyo, Japan. 11. Department of Biostatistics and Epidemiology, Yokohama City University, Yokohama, Japan.
Abstract
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.
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 cancerpatients 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.
Authors: Kevin W Göttgens; Reinier R Smeets; Laurents P Stassen; Geerard Beets; Stephanie O Breukink Journal: Dis Colon Rectum Date: 2014-07 Impact factor: 4.585
Authors: Andrea Balla; Silvia Quaresima; José D Subiela; Mostafa Shalaby; Giuseppe Petrella; Pierpaolo Sileri Journal: Int J Colorectal Dis Date: 2018-05-10 Impact factor: 2.571