Guidelines for Complications of Cancer Treatment Vol VIII Part B

Based on our institutional practice, we recommend twoweeks of conservative therapy for non-radiated tissue.The conservative therapy may be 4-6 weeks in radiatedtissue.Surgical intervention is recommended for1) Large and high output fistulae2) Skin breakdown.3) Major blood vessel exposure/bleedingGeneral Measures Nil per orally Enteral feeding and correction of any attendant anemiaor hypoproteinaemia. Appropriate antibiotics which may be guided by culturesensitivity reportsWound management Local wound care that consists of frequent change ofdressing thereby allowing good drainage of saliva. Weprefer putting corrugated drains as the drainage is betterand they do not get blocked. Also a continuous negativesuction drain may impede the closure of the fistula All attempts should be made to divert the fistula awayfrom the stoma to prevent aspiration into lungs In case of aspiration because of drainage into the stoma,a cuffed tracheostomy tube will help in preventing thesame.Surgical intervention Surgical closure may utilize healthy tissue around thefistula.205