Clinical Impact of Transanal Drainage Tube on Anastomosis Leakage following Minimally Invasive Anterior Resection without Diverting Stoma in Patients with Rectal Cancer: A Propensity Score-Matched Analysis

Abstract

Purpose As one of the most serious complications of rectal cancer (RC) surgery, preventing anastomotic leakage (AL) is crucial. Several studies have suggested a positive role of the transanal drainage tube (TaDT) in AL prevention. However, whether TaDT is beneficial for AL after anterior resection (AR) for RC remains controversial. The present study aimed to evaluate the clinical impact of TaDT on AL following minimally invasive AR without diverting stoma (DS) in patients with RC. Methods We retrospectively analyzed 392 consecutive patients with RC who had undergone minimally invasive AR without DS between 2010 and 2021. Propensity score-matching (PSM) was performed to reduce selection bias. Results A TaDT was used in 214 patients overall. After PSM, we enrolled 316 patients. Before PSM, significant group-dependent differences were observed in terms of age, American Society of Anesthesiologists physical status, and use of anti-platelet/anti-coagulant agents. The frequency of AL was 7.3% in the overall cohort, and was significantly lower in the TaDT group (3.7%) than in the Non-TaDT group (11.8%). The rate of Grade B AL was significantly lower in the TaDT group than in the Non-TaDT group. However, no significant differences between groups were found for Grade C AL. Moreover, multivariate analysis identified lack of a TaDT as an independent risk factor for AL in the overall and matched cohorts. Conclusions These results indicated that TaDT may play a beneficial role in preventing AL, particularly of Grade B, for patients with RC undergoing minimally invasive AR without DS.