title: Radiation-induced rectovaginal fistulas in locally advanced gynaecological malignancies-new patients, old problem?
abstract: OBJECTIVE
  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.
authors.affiliation: Department of General and Colorectal Surgery, Medical University of Lodz, Plac Hallera 1, 90-647, Lodz, Poland. piotr_zelga@op.pl.
authors.forename: Piotr
authors.identifier: http://orcid.org/0000-0003-1311-7980
authors.initials: P
authors.lastname: Zelga
authors.affiliation: Department of General and Colorectal Surgery, Medical University of Lodz, Plac Hallera 1, 90-647, Lodz, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Tchórzewski
authors.affiliation: Department of General and Colorectal Surgery, Medical University of Lodz, Plac Hallera 1, 90-647, Lodz, Poland.
authors.forename: Marta
authors.initials: M
authors.lastname: Zelga
authors.affiliation: Brachytherapy Unit, Regional Oncological Centre in Lodz, Pabianicka 62, Lodz, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Sobotkowski
authors.affiliation: Department of General and Colorectal Surgery, Medical University of Lodz, Plac Hallera 1, 90-647, Lodz, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Dziki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy*; D006801:Humans; D007081:Ileostomy; D008875:Middle Aged; D018579:Patient Selection; D011788:Quality of Life; D012006:Rectovaginal Fistula / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Diverting stoma; Radiation therapy; Rectovaginal fistula