Efficacy of transanal tube placement after anterior resection for rectal cancer: a systematic review and meta-analysis

Wang, Shuanhu; Zhang, Zongbing; Liu, Mulin; Li, Shiqing; Jiang, Congqiao

doi:10.1186/s12957-016-0854-0

Cited by 34 publications

(28 citation statements)

References 32 publications

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“…In addition, surgical stoma closure under general anesthesia confers additional stress on patients. A meta-analysis has shown that transanal tube positioning helps to lower the postoperative incidence of AL, hence reducing the necessity for subsequent reoperation [ 38 ]. In contrast, the AL rate was significantly higher in 11 (61%) of the 18 patients who required transanal drainage in the present study.…”

Section: Discussionmentioning

confidence: 99%

Male sex and history of ischemic heart disease are major risk factors for anastomotic leakage after laparoscopic anterior resection in patients with rectal cancer

et al. 2018

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BackgroundAnastomotic leakage (AL) is the most serious and common complication of surgery for rectal cancer, and associated risk factors remain unknown despite developments in laparoscopic surgery. The present study aimed to determine risk factors for AL after laparoscopic anterior resection (AR) of rectal cancer.MethodsThis retrospective cohort study extracted information from a prospective database of all consecutive colorectal resections that proceeded at Nippon Medical School Hospital between January 2011 and December 2015 (n = 865). We identified 154 patients with rectal cancer treated by elective laparoscopic AR with anastomosis using primary double-stapling. Clinical variables and comorbidity, habits, and surgery-related variables were assessed by univariate and multivariate analyses to determine preoperative risk factors for clinical AL.ResultsThe overall rate of clinical AL was 11.7% (18 of 154 patients), and 5 (27.8%) of 18 patients required revised laparotomy. Data from males were analyzed because AL occurred only in males. Univariate analysis of male patients (n = 100) significantly associated preoperative creatinine values (p = 0.03) and a history of ischemic heart disease (IHD) (p = 0.012) with AL. The frequency of AL tended to increase (p = 0.06) when patients had low AR (p = 0.06) and transanal drainage. Having AL significantly prolonged hospital stays compared with patients without leakage (36.2 vs. 11.1 days; p < 0.01). Multivariate analysis identified a history of IHD (odds ratio [OR], 4.73; 95% confidence interval [CI], 1.27–17.5; p = 0.025] as an independent risk factor for AL.ConclusionsMale sex and a history of IHD are possible risk factors for AL after elective laparoscopic rectal cancer surgery.

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Section: Discussionmentioning

confidence: 99%

Male sex and history of ischemic heart disease are major risk factors for anastomotic leakage after laparoscopic anterior resection in patients with rectal cancer

et al. 2018

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“…5 However, the incidence of anastomotic leakage after such surgery has also increased ranging from 4% to 26% drawing attention to this serious problem. 6,7 Possible factors contributing to this problem include the reduced blood supply of the anorectal remnant and the large pelvic cavity after TME, which predispose to potential fluid accumulation and pelvic infection complicated by poor anastomotic healing post (neo)adjuvant radiotherapy. 8,9 The leak rates are significantly high if there is no diverting ileostomy (44.4% versus 12.7% respectively).…”

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confidence: 99%

Loop transverse colostomy versus loop ileostomy after low and ultralow anterior resection

Ali

2018

Int Surg J

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Background: Since the introduction of sphincter saving procedures for low and mid-rectal carcinoma and the associated high anastomotic leakage rate is a matter of troublesome. There is a consensus between surgeons that diverting proximal stoma decreases the incidence of clinical leakage. But the choice between loop transverse colostomy (LTC) and loop ileostomy (LI) still a matter of debate. In this study we tried to compare both methods and evaluate the outcome of each.Methods: This is a prospective observational study included 28 patients suffering from mid- or low-rectal cancer who underwent elective low anterior resection (LARs), admitted to Sohag University Hospital between July 2013 to July 2017. Patients were randomly allocated into two groups; group (A) included 15 patients and managed with LTC, and group (B) included 13 patients and managed with LI. The data of the patients were collected, tabulated and analyzed, with special consideration of the general outcome measures related to stoma construction, special outcome measures related to stoma construction, and the outcome measures related to stoma closure. All of the patients were followed up for 6 months.Results: Author found a significantly higher incidence rate of skin excoriation (p<0.001), leaks from the appliance (p<0.005), in the LI group than in the LTC group and higher incidence of parastomal hernia (p=0.042) in the LTC than in the LI. Also, author found a significantly higher incidence rate of intestinal obstruction in the LI group (p<0.001), also we found a significantly higher incidence of wound infection after stoma closure (p=0.006) in the LTC group than in the LI group. The mean time to first bowel movement (days) was earlier in the LI than LTC group and showing also a significant value (p<0.001). The mean cumulative total hospital stay was significantly longer in the LTC group than in the LI group (p<0.001).Conclusions: LTC and LI; both have advantages and disadvantages and the use of any for fecal diversion after low and mid-rectal carcinoma should be considered for every patient individually according to his circumstances.

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“…Results of both the meta-analysis of the three observational studies and the one randomized trials indicate that placement of a transanal tube significantly decreases the risk of leakage and reoperation [16]. While the mechanism of action of the transanal tube is unclear, it may be related to reduction in endoluminal pressure in the anastomotic portion of the intestine which may be an important factor in anastomotic leakage [17]. Although transanal tube may reduce the risk of anastomotic leakage and reoperation, its placement increases patients' discomfort and inconvenience.…”

Section: Resultsmentioning

confidence: 98%

Efficacy and Safety of Transanal Tube Drainage for Prevention of Anastomotic Leakage Following Laparoscopic Low Anterior Resection for Rectal Cancers

Uchima¹,

Aomatsu²,

Miyamoto³

et al. 2018

JCT

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Introduction: Laparoscopic surgery is widely used for the treatment of colorectal cancer. But anastomotic leakage is one of the most serious complications following laparoscopic low anterior resection (LAR) for rectal cancer. The purpose of this study was to investigate whether transanal drainage tube placement can reduce anastomotic leakage and avoid re-operation after laparoscopic LAR. Methods: Retrospective assessment was performed on 143 patients with rectal cancers who underwent laparoscopic LAR between April 2009 and March 2016. A diverting stoma was not created in all 143 patients. A transanal drainage tube was placed after anastomosis using a double stapling technique, in 90 patients (group TT). In group TT, a 24 Fr. Silicon catheter was inserted into the anus and was placed approximately 20-25 cm in the descending colon. Another 53 patients were operated on without a transanal drainage tube (group NTT). Clinicopathological and operative variables, the frequencies of anastomotic leakage and re-operation after leakage were investigated. Results: Between the two groups (Group TT and NTT), age, gender, body mass index, tumor size, Dukes' stage, the number of Liniar stapler firings for rectal transaction, and the rate of left colic artery preservation were comparable. Intra-operative blood loss and operation time decreased group TT from group NTT (p < 0.05). The frequency of leakage was 2.8% (2/69) in group TT and was 13.2% (7/53) in group NTT. The rate of leakage was significantly lower in group TT (p = 0.03). Furthermore, the re-operation rate for symptomatic anastomotic leakage was 0% (0/2) in group TT, while in contrast it was 28.5% (2/7) in group NTT. The rate of re-operation was lower in group TT than group NTT (p = 0.07) and all cases with symptomatic leakage in

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Efficacy of transanal tube placement after anterior resection for rectal cancer: a systematic review and meta-analysis

Cited by 34 publications

References 32 publications

Male sex and history of ischemic heart disease are major risk factors for anastomotic leakage after laparoscopic anterior resection in patients with rectal cancer

Male sex and history of ischemic heart disease are major risk factors for anastomotic leakage after laparoscopic anterior resection in patients with rectal cancer

Loop transverse colostomy versus loop ileostomy after low and ultralow anterior resection

Efficacy and Safety of Transanal Tube Drainage for Prevention of Anastomotic Leakage Following Laparoscopic Low Anterior Resection for Rectal Cancers

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