An Approach to Rectovaginal Fistulae in Advanced Cancer: The Central Role of Palliative Care

Abstract

The development of rectovaginal fistulae in patients with advanced pelvic malignancies can lead to significant morbidity and suffering. It represents a heavy burden on patients, dealing with local symptoms, psychological distress, and self-image issues, contributing to poor quality of life. It also represents a challenge for clinicians due to the need for multiple professional interventions, need for continuity of care and regular clinical reevaluation. Palliative care professionals play a central role in these cases. Nevertheless, literature in this specific context is lacking. We present a narrative review on this topic, focusing on conservative treatment with both pharmacological measures to control fistula effluent and local care to prevent complications; psychological and spiritual support addressing self-image, self-esteem, and sexuality issues. A summary review of the aetiology, symptomatology, diagnosis and surgical approach is also carried out.