Rectovaginal fistula following double-stapling anastomosis in low anterior resection for rectal cancer.

The rectovaginal fistula is a rare complication after low anterior resection for rectal cancer, but its management is difficult and the result is often unsatisfactory. Herewith, we report one patient with rectovaginal fistula as a postoperative complication. Rectovaginal fistula appeared on the 23rd day after low anterior resection. Flatus and feces through the vagina were present, but the fistula was too small to be elucidated by gastrografin enema. After 22 days of fasting therapy under total parenteral nutrition, this fistula was closed. The rectovaginal fistula is very rare but is a possible complication after low anterior resection for rectal cancer. Therefore, this complication must be kept in mind, and a minimal-sized fistula can be treated conservatively without a diverting colostomy or other surgical procedures.

[Progress in adjuvant therapy for colorectal cancer].

The progress and role of adjuvant therapy for resectable colorectal cancers are reviewed herein. 5-FU/leucovorin is considered the standard treatment in the postoperative adjuvant chemotherapy for Dukes'C colon cancer. The oral 5-FU prodrugs, such as UFT and capecitabine, will replace 5-FU infusion in the adjuvant chemotherapy in the near future. In Dukes'B colon cancer, the results of postoperative adjuvant chemotherapy are controversial. Many randomized trials in the USA and Europe have demonstrated that pre- or postoperative radiation therapy for rectal cancer decreases local recurrences but has no additional benefit on survival compared with 5-FU-based adjuvant chemotherapy. Adjuvant radiation therapy for rectal cancer is not widely used in Japan, while chemotherapy is considered the adjuvant treatment of choice. The local recurrences of rectal cancer is a surgeon-related phenomenon: the surgical technique used and the skill of the surgeon are major factors influencing outcome.