Multidisciplinary Approach to Management of Fistulae in Gynaecological Oncology - 5 Year Experience

Download or read book Multidisciplinary Approach to Management of Fistulae in Gynaecological Oncology - 5 Year Experience written by Alexandra Lawrence and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Aims: This is a retrospective observational study of our experience with diagnosis and multispecialty management of complex fistula in gynaecological oncology.Background: Fistulas are uncommon complications in gynaecological malignancies; commonest occurring fistulas are vesico-vaginal and enterocutaneous fistula. They may develop after primary malignancy, surgery, recurrence or radiation therapy. We report an observational cohort study.Methods: Prospective identification and data collection on all cases with fistula related to gynaecological malignancy was undertaken between 2014 and 2018. Patient demographics, co-morbidities, cancer type & stage, investigations, management and outcomes were collated and analysed using descriptive statistics. Results: A total of 17 patients were identified (1% total n=1485), out of which 12 developed a fistula post operatively, 4 after chemo radiotherapy, and 1 case post recurrence. Among the 17 patients, 5 patients developed Enterocutaneous fistula, 3 uretro-vaginal fistula, 3 vesico-vaginal fistula, 3 rectovaginal fistula and 3 colovaginal fistula. CT scan was the main diagnostic tool in all these case. There were no correlations between developing a fistula and age, BMI, previous abdominal surgery, type or stage of cancer and type of procedure. All fistulas were managed with multidisciplinary approach from the outset, including medical & clinical oncology, nutrition, interventional radiology, colorectal & urological surgeons, tissue viability, and extensive clinical nurse specialist support. Vesico-vaginal fistulas and post-radiotherapy rectovaginal and colovaginal fistulas were managed surgically. All others were managed conservatively with full resolution. Conclusion: Fistulas in gynaecological oncology are an uncommon complication. CT scan is the preferred imaging modality for diagnosis. Early multi-disciplinary approach is pivotal to successful management.