Incidence and risk factors of rectovaginal fistula after rectal cancer surgery:a systematic review and meta-analysis

BackgroundRectovaginal fistula (RVF) is a unique complication for women after rectal cancer surgery (RCS). Understanding its incidence and risk factors can help further recognize and prevent the disease. Although there have been studies on the risk factors for RVF after RCS, the results show some heterogeneity and even contradictory conclusions due to differences in trial design, sample size, study population, and treatment methods, etc. However, no relevant meta-analyses have been found to date. This study aims to investigate the incidence and risk factors of RVF after RCS through a meta-analysis. MethodsA systematic literature was conducted in PubMed, Embase, Web of Science, and Cochrane Library from the establishment of the database to June 2024. The quality of the literature was evaluated using the Newcastle-Ottawa scale. Meta-analysis was performed using R Studio 4.3.2 software. ResultsA total of 1 randomized controlled study and 7 non-randomized controlled studies were included, involving 4920 patients, among which 134 cases had RVF. The meta-analysis results showed that the incidence of RVF after RCS was 3.2% (95%CI: 1.9% [~] 7.8%). Neoadjuvant chemoradiotherapy,tumors in lower position,longer surgery duration and double-stapled technique were risk factors for the occurrence of RVF after RCS. Laparoscopic technique was a protective factor for RVF after RCS. T4 stage,age,diabetes,ASA anesthesia classification, Prior hysterectomy, Combined pelvic organ resection, and vaginectomy had no significant effect on RVF. ConclusionThe incidence of RVF after RCS is higher than the general cognition, which should be paid attention to by surgeons. The results of this study may help surgeons identify high-risk inpatients in time, take corresponding measures in advance, and expect to reduce the incidence of the disease.