ENTEROCUTANEOUS FISTULA IN CANCER-PATIENTS - ETIOLOGY, MANAGEMENT, OUTCOME, AND IMPACT ON FURTHER TREATMENT

Enterocutaneous fistulae that develop in patients with cancer represen t a difficult management situation, which is often complicated by prio r treatment including surgery, radiation therapy, and chemotherapy. A fistula may in turn delay potentially beneficial treatment of the unde rlying malignancy. To provide a better understanding of this problem, we reviewed the National Institutes of Health experience with enterocu taneous fistulae in adult patients with cancer. The medical records of patients with cancer who developed a fistula from the gastrointestina l tract during the period 1980 through 1994 were reviewed. Etiology, m anagement, outcome, and impact on further treatment were assessed. Twe nty-five patients with gastrointestinal fistulae were identified. The most common primary tumor site was the colon/rectum in males and the o vary in women. The majority of patients had metastatic disease at diag nosis and a history of prior therapy and presented with anorexia and w eight loss. The fistula was usually single, most commonly developed fr om the jejunum/ileum (13 patients) or colon/rectum (6 patients), and o ccurred postoperatively after procedures on the small bowel (10 patien ts) or colon (8 patients). Malnutrition and sepsis developed in 60 per cent of patients. Thirty-day mortality was 16 per cent and correlated with prior radiation therapy, location and output from the fistula, a nd hypoalbuminemia. An enterocutaneous fistula negatively impacted on the provision of further therapy for the majority of patients (63%). E nterocutaneous fistula in the patient with cancer occurs most frequent ly in the setting of extensive prior therapy and is associated with pr olonged morbidity. Identification of high-risk patients and early mana gement of fistulas once they develop may prevent delays in subsequent cancer therapy and decrease morbidity.