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

Abstract

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.

Risk Factors for Rectal Stump Leakage After Discontinuity Resection: Stump Length Matters Most

“…The benefit of percutaneous and transanal drainages in elective colorectal surgery regarding AL is controversial. 33–38 In our collective, prophylactic RS drainage did not reduce RSL. In fact, irrigation-suction and transanal drains were associated with increased RSL rates; however, it is for now unclear whether they causally contribute to RSL (ie, via mechanical irritation, foreign body reaction, or transdermal infection) or whether they are intentionally and more frequently placed in high-risk constellations.…”

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

“…Several studies and meta-analyses have found similar results to our study. Guo et al [14] conducted a meta-analysis using the data from three randomized controlled trials (RCTs) and 16 observational studies (prospective or retrospective), nding that use of a TaDT correlated with a reduction in AL in observational studies. A systematic review and meta-analysis conducted by Wang et al indicated that placement of a TaDT decreased the rates of both clinical AL and reoperation related to AL [26].…”

“…observational cohort studies concluded that TaDT might represent an e cient and economic intervention for preventing AL after RC surgery [8]. Conversely, Guo et al [14] suggested that using a TaDT in patients with RC did not correlate with any detectable differences in AL according to RCTs. Summarizing the current literature, results were as heterogeneous as they were different in study designs.…”

“…Several studies have reported that the placement of a transanal drainage tube (TaDT) can reduce endoluminal pressure on the anastomotic site after AR for RC [8][9][10][11][12][13]. However, several publications have reported con icting results on associations between TaDT and AL [14][15][16]. Whether a TaDT at the anastomosis site is bene cial for AL after AR for RC thus remains controversial.…”

Clinical Impact of Transanal Drainage Tube on Anastomosis Leakage Following Minimally Invasive Resection Without Diverting Stoma in Patients With Rectal Cancer: A Propensity Score-matched Analysis

“…[9][10][11][12][13][14] On the other hand, several publications have also reported conflicting results on associations between TaDT and AL. [15][16][17] Owing to the inherent limitations of the retrospective methodology, relatively small sample size, and nonconcurrent controls, the level of evidence for the application of TaDTs was low, and there were subsequent concerns regarding patient selection bias in these studies. Currently, only a few studies have compared the use of a TaDT to a without TaDT in terms of the rate of AL and perioperative outcomes in patients without a DS.…”