title: Incidence and risk factors for rectovaginal fistula after low anterior resection for rectal cancer.
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.
authors.affiliation: Department of Surgery, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka, 238-8558, Japan. nabe-jun@comet.ocn.ne.jp.
authors.forename: Jun
authors.initials: J
authors.lastname: Watanabe
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan.
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Ota
authors.affiliation: Department of Surgery, Yokohama Municipal Citizen's Hospital, Yokohama, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kawaguchi
authors.affiliation: Department of Surgery, Yokosuka Municipal Citizen's Hospital, Yokosuka, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Shima
authors.affiliation: Department of Surgery, Yokosuka Kyosai Hospital, 1-16 Yonegahama Street, Yokosuka, 238-8558, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Kaida
authors.affiliation: Department of Surgery, Yokohama City Minato Red Cross Hospital, Yokohama, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Osada
authors.affiliation: Department of Surgery, Yokohama Hodogaya Central Hospital, Yokohama, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kamimukai
authors.affiliation: Department of Surgery, Ito Municipal Hospital, Ito, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Kamiya
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ishibe
authors.affiliation: Department of Surgery, NTT Medical Center, Tokyo, Japan.
authors.forename: Kazuteru
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Ryusei
authors.initials: R
authors.lastname: Matsuyama
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Akiyama
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ichikawa
authors.affiliation: Department of Biostatistics and Epidemiology, Yokohama City University, Yokohama, Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Oba
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications; D010535:Laparoscopy; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012006:Rectovaginal Fistula / Q000209:etiology*; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Anastomotic leakage; Anastomotic-vaginal fistula; Low anterior resection; Rectal cancer; Rectovaginal fistula