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EP708 Multidisciplinary approach to management of fistulae in gynaecological oncology – 5 year experience
  1. A Farrag1,
  2. D Chandrasekaran1,
  3. M Powell2,
  4. E Brockbank1,
  5. A Lawrence1,
  6. A Jeyarajah1,
  7. R Miller3 and
  8. S Phadnis1
  1. 1Department of Gynaecological Oncology, Barts Health NHS Trust, The Royal London Hospital
  2. 2Department of Clinical Oncology
  3. 3Department of Medical Oncology, Barts Health NHS Trust, St Bartholomew’s Hospital, London, UK


Introduction/Background Fistulas are uncommon complications in gynaecological malignancies; commonest occurring fistulas are vesicovaginal and enterocutaneous fistula. They may develop after primary malignancy, surgery, recurrence or radiation therapy. We report an observational cohort study.

Methodology 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.

Disclosure AF, DC, MP, EB, AL, ARJ, RM, SP declare no conflict of interest.

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