Postoperative Colovesical Fistula in Colorectal Cancer Patients: A Comprehensive Review

Postoperative colovesical fistula (CVF) is a rare but serious complication of colorectal cancer (CRC) surgery that typically results from locally advanced tumors or surgical complications. This review summarizes the current knowledge on postoperative CVF, focusing on its epidemiology, clinical presentation, diagnostic evaluation, surgical management, and outcomes. CVFs predominantly affect older male patients and often arise from either direct bladder tumor invasion or postoperative anastomotic leakage. Patients usually present with urinary symptoms, such as pneumaturia, fecaluria, and recurrent urinary tract infections, making prompt diagnosis essential to prevent serious morbidity. Computed tomography (CT) is the first-line diagnostic modality complemented by magnetic resonance imaging (MRI), colonoscopy, and cystoscopy to characterize fistulas and guide surgical planning. Definitive treatment is surgery, involving resection of the affected bowel segment and repair of the bladder, with a preference for minimally invasive techniques when feasible. Staged procedures and conservative management are reserved for high-risk patients, particularly those with significant comorbidities or uncontrolled infections. Emerging evidence suggests that laparoscopic and robotic approaches are associated with fewer postoperative complications and shorter hospital stays than open surgery. Outcomes after surgical repair are generally favorable, with low fistula recurrence and marked improvement in the patient’s quality of life. Prognosis largely depends on the tumor stage and completeness of oncological resection. Overall, timely, tailored surgical intervention supported by modern imaging and optimized perioperative care yields favorable outcomes, with prolonged survival and improved quality of life in this population.