Restorative resection of radiation rectovaginal fistula can better relieve anorectal symptoms than colostomy only.
BACKGROUND
Radiation-induced rectovaginal fistula (RVF) is a severe and difficult complication after pelvic malignancy radiation. This study was to retrospectively compare the outcomes of restorative resection and colostomy only in remission of anorectal symptoms.


METHODS
We enrolled a cohort of 26 consecutive cases who developed RVF after pelvic radiation. Two main procedures for these patients in our institution were used: one was restorative resection and pull-through coloanal anastomosis with a prophylactic colostomy, and another was a simple colostomy without resection. Thus, we divided these patients into these two groups. Anorectal symptoms including rectal pain, bleeding, tenesmus, and perineal mucous discharge were recorded and scored prior to surgery and at postoperative multiple time points.


RESULTS
The baseline was similar among the two groups. All patients acquired good efficacy with improved symptoms at postoperative 6, 12, and 24 months, when compared to baseline. In addition, the resection group showed a better remission of tenesmus (6 months 33.3 vs 0%; 12 months 66.7 vs 16.7%) and perineal mucous discharge (6 months 88.9 vs 6.7%; 12 months 77.8 vs 15.4%; 24 months 85.7 vs 25.0%). Furthermore, three (30%) patients in the resection group successfully reversed stomas while no stoma was closed in the simple colostomy group.


CONCLUSIONS
Both restorative resection procedure and colostomy only can improve anorectal symptoms of radiation-induced RVF, but restorative resection can completely relieve anorectal symptoms in selected cases.
Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China.
Qinghua
Q
Zhong
Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China.|Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA.
Zixu
Z
Yuan
Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China.
Tenghui
T
Ma
Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China.
Huaiming
H
Wang
Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China.
Qiyuan
Q
Qin
Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China.
Lili
L
Chu
Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China.|Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor, Sun Yat-sen University, No.26, Road Yuancun ErHeng Road, Tianhe District, Guangzhou, 510655, China.
Jianping
J
Wang
Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China. leiwangyinhu@126.com.|Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor, Sun Yat-sen University, No.26, Road Yuancun ErHeng Road, Tianhe District, Guangzhou, 510655, China. leiwangyinhu@126.com.
Lei
L
Wang
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000473:pathology / Q000601:surgery*; D000714:Anastomosis, Surgical; D003125:Colostomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010386:Pelvic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects*; D012006:Rectovaginal Fistula / Q000209:etiology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D054047:Surgical Stomas
Colostomy; Radiation-induced intestinal injury; Rectovaginal fistula; Restorative resection