Effectiveness of a Transanal Drainage Tube for the Prevention of Anastomotic Leakage after Laparoscopic Low Anterior Resection for Rectal Cancer

Wang, Zheng; Liang, Jianwei; Chen, Jianan; Mei, Shiwen; Liu, Qian

doi:10.31557/apjcp.2020.21.5.1441

Cited by 22 publications

(24 citation statements)

References 20 publications

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“…According to the ROBINS‐I tool and the Cochrane risk‐of‐bias assessment tool, 11 cohort studies [27–33, 34–36, 39] were ranked as low risk of bias, five cohort studies [24, 25, 34, 37, 40] were ranked as moderate risk of bias and one cohort study [38] as serious risk of bias (Figure 2). The randomization of the RCTs [16, 22, 23] was implemented by a central automated randomization website and allocation was concealed using closed envelopes.…”

Section: Resultsmentioning

confidence: 99%

“…Sixteen studies [24, 25, 27–40] reported AL rate as an outcome measure. Patients receiving TDT had a significantly decreased risk of anastomotic leak compared with the non‐TDT group; 7.3% (123/1694) of TDT patients reported AL at follow‐up compared to 12.6% (221/1751) of the non‐TDT group with a pooled OR of 0.44 (95% CI 0.30–0.64, P < 0.0001; Figure 5).…”

Section: Resultsmentioning

confidence: 99%

“…Reoperation rate was reported in 15 studies [24, 25, 27–31, 33–40], enrolling 3207 patients. Reoperation was evident in 3.4% (53/1555) of patients following TDT versus 7.1% (117/1652) of the non‐TDT group (OR 0.47, 95% CI 0.33–0.69, P < 0.0001).…”

Section: Resultsmentioning

confidence: 99%

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Prophylactic transanal drainage tube placement for preventing anastomotic leakage after anterior resection for rectal cancer: A meta‐analysis

Guo

Qing

et al. 2022

Colorectal Disease

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Aim:The aim was to evaluate the efficacy of transanal drainage tube (TDT) placement for preventing anastomotic leakage after low anterior resection for rectal cancer. Method: PubMed, the Cochrane Central Register of Controlled Trials, Embase and Clini calTr ials.gov databases were searched up to October 2021. Studies comparing outcomes following low anterior resection with or without TDT were included. The primary outcomes measured were anastomotic leakage rate, reoperation rate and anastomotic bleed rate.Results: Three randomized controlled trials (RCTs) and 16 observational studies (prospective or retrospective) involving 4560 patients satisfied the basic inclusion criteria.In RCTs, a TDT was associated with no statistically significant differences in anastomotic leakage (OR = 0.67, 95% CI 0.42-1.05, P = 0.08), reduction in reoperation (OR = 0.11, 95% CI 0.03-0.51, P = 0.004) and increased anastomotic bleeding rate (OR = 2.36, 95% CI 1.11-5.01, P = 0.03). In observational studies, a TDT was associated with significant reduction in anastomotic leak (OR = 0.44, 95% CI 0.30-0.64, P < 0.0001) and reoperation (OR = 0.47, 95% CI 0.33-0.69, P < 0.0001), with no statistically significant differences in anastomotic bleeding (OR = 1.30, 95% CI 0.20-8.30, P = 0.78). Conclusion:In RCTs, a TDT for rectal cancer was correlated with no detectable differences in anastomotic leakage and with an increased risk of anastomotic bleeding. In observational studies, a TDT was correlated with reduction in anastomotic leakage and no detectable differences in anastomotic bleeding. Both RCTs and observational studies demonstrated a comparable reduction in reoperation rate with TDT. These data in aggregate indicated that TDTs may not show superiority but emphasized differences between RCT and observational data.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Prophylactic transanal drainage tube placement for preventing anastomotic leakage after anterior resection for rectal cancer: A meta‐analysis

Guo

Qing

et al. 2022

Colorectal Disease

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“…In addition to stent therapy, studies have shown that TIDTs, which are placed 3-5 cm above the anastomosis, can be used to prevent anastomotic leakage after rectal cancer resection[ 14 , 18 ], and some studies have shown that anastomotic leakage cannot be prevented[ 19 ]. After the intestinal cavity is sealed by the balloon, artificial intestinal obstruction may occur, which easily promotes intestinal peristalsis, and the TIDTs are easily discharged.…”

Section: Discussionmentioning

confidence: 99%

Metal stent combined with ileus drainage tube for the treatment of delayed rectal perforation: A case report

Cheng¹,

Xie²,

Wu³

et al. 2022

WJCC

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BACKGROUND Acute iatrogenic colorectal perforation (AICP) is a serious adverse event, and immediate AICP usually requires early endoscopic closure. Immediate surgical repair is required if the perforation is large, the endoscopic closure fails, or the patient's clinical condition deteriorates. In cases of delayed AICP (> 4 h), surgical repair or enterostomy is usually performed, but delayed rectal perforation is rare. CASE SUMMARY A 53-year-old male patient underwent endoscopic submucosal dissection (ESD) at a local hospital for the treatment of a laterally spreading tumor of the rectum, and the wound was closed by an endoscopist using a purse-string suture. Unfortunately, the patient then presented with delayed rectal perforation (6 h after ESD). The surgeons at the local hospital attempted to treat the perforation and wound surface using transrectal endoscopic microsurgery (TEM); however, the perforation worsened and became enlarged, multiple injuries to the mucosa around the perforation and partial tearing of the rectal mucosa occurred, and the internal anal sphincter was damaged. As a result, the perforation became more complicated. Due to the increased bleeding, surgical treatment with suturing could not be performed using TEM. Therefore, the patient was sent to our medical center for follow-up treatment. After a multidisciplinary discussion, we believed that the patient should undergo an enterostomy. However, the patient strongly refused this treatment plan. Because the position of the rectal perforation was relatively low and the intestine had been adequately prepared, we attempted to treat the complicated delayed rectal perforation using a self-expanding covered mental stent (SECMS) in combination with a transanal ileus drainage tube (TIDT). CONCLUSION For patients with complicated delayed perforation in the lower rectum and adequate intestinal preparation, a SECMS combined with a TIDT can be used and may result in very good outcomes.

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“…Rectal cancer is one of the most common malignancies worldwide (Wang et al, 2020). Recently, laparoscopic low anterior resection (LAR) with total mesorectal excision (TME) has been commonly performed for middle and lower rectal cancers (Heald and Ryall, 1986;Peeters et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Short-Term Outcomes for Laparoscopic Surgery for BMI≥30 Patients with Rectal Cancer

Zhang

Liu

Chen

et al. 2021

Asian Pac J Cancer Prev

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Objective: Obesity is known to be a preoperative risk factor for rectal cancer surgery. This study aimed to investigate the influence of obesity on the surgical outcomes of laparoscopic surgery for rectal cancer. Methods: The clinical data of 356 patients with rectal cancer from Jan 2012 to Dec 2015 were analyzed retrospectively. Perioperative outcomes were compared between 48 patients with a BMI (body mass index) ≥30 kg/m 2 [obese group ] and 308 patients with a BMI≥30 kg/m 2 [non-obese group] who underwent laparoscopic surgery. Results: Operation times were significantly longer for the obese group than for the non-obese group (125.2±30.5 min vs. 180.5±58.2 min, P=0.021). There were no statistically significant differences between two groups in terms of intraoperative blood loss, the number of retrieved lymph nodes, postoperative recovery and postoperative complications (P≥0.05). During the follow-up period, the overall survival rates were not significantly different between the two groups [66.7% (32/48) vs 67.2% (207/308), P=0.787]. The differences in recurrence and metastasis between the two groups were not statistically significant. Conclusion: Our analysis revealed that laparoscopic surgery can be safely performed in patients with BMI≥30. The procedure was considered to be difficult but sufficiently feasible.

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Effectiveness of a Transanal Drainage Tube for the Prevention of Anastomotic Leakage after Laparoscopic Low Anterior Resection for Rectal Cancer

Cited by 22 publications

References 20 publications

Prophylactic transanal drainage tube placement for preventing anastomotic leakage after anterior resection for rectal cancer: A meta‐analysis

Prophylactic transanal drainage tube placement for preventing anastomotic leakage after anterior resection for rectal cancer: A meta‐analysis

Metal stent combined with ileus drainage tube for the treatment of delayed rectal perforation: A case report

Short-Term Outcomes for Laparoscopic Surgery for BMI≥30 Patients with Rectal Cancer

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