Transanal Drainage Tube Use for Preventing Anastomotic Leakage After Laparoscopic Low Anterior Resection in Patients With Rectal Cancer

Abstract

Preventing anastomotic leakage (AL) is crucial for colorectal surgery. Some studies have suggested a positive role of transanal drainage tubes (TDTs) in AL prevention after low anterior resection, but this finding is controversial.OBJECTIVE To assess the effect of TDTs in AL prevention after laparoscopic low anterior resection for rectal cancer. DESIGN, SETTING, AND PARTICIPANTSThis multicenter randomized clinical trial with parallel groups (TDT vs non-TDT) was performed from February 26, 2016, to September 30, 2020. Participants included patients from 7 different hospitals in China who were undergoing laparoscopic low anterior resection with the double-stapling technique for mid-low rectal cancer; 576 patients were initially enrolled in this study, and 16 were later excluded. Ultimately, 560 patients were randomly divided between the TDT and non-TDT groups.INTERVENTIONS A silicone tube was inserted through the anus, and the tip of the tube was placed approximately 5 cm above the anastomosis under laparoscopy at the conclusion of surgery. The tube was fixed with a skin suture and connected to a drainage bag. The TDT was scheduled for removal 3 to 7 days after surgery. MAIN OUTCOMES AND MEASURESThe primary end point was the postoperative AL rate within 30 days. RESULTSIn total, 576 patients were initially enrolled in this study; 16 of these patients were excluded. Ultimately, 560 patients were randomly divided between the TDT group (n = 280; median age, 61.5 years [IQR, 54.0-68.8 years]; 177 men [63.2%]) and the non-TDT group (n = 280; median age, 62.0 years [IQR, 52.0-69.0 years]; 169 men [60.4%]). Intention-to-treat analysis showed no significant difference between the TDT and non-TDT groups in AL rates (18 [6.4%] vs 19 [6.8%]; relative risk, 0.947; 95% CI, 0.508-1.766; P = .87) or AL grades (grade B, 14 [5.0%] and grade C, 4 [1.4%] vs grade B, 11 [3.9%] and grade C, 8 [2.9%]; P = .43). In the stratified analysis based on diverting stomas, there was no significant difference in the AL rate between the groups, regardless of whether a diverting stoma was present (without stoma, 12 [5.8%] vs 15 [7.9%], P = .41; and with stoma, 6 [8.3%] vs 4 [4.5%], P = .50). Anal pain was the most common complaint from patients in the TDT group (130 of 280, 46.4%). Accidental early TDT removal occurred in 20 patients (7.1%), and no bleeding or iatrogenic colonic perforations were detected. CONCLUSIONS AND RELEVANCEThe results from this randomized clinical trial indicated that TDTs may not confer any benefit for AL prevention in patients who undergo laparoscopic low anterior resection for mid-low rectal cancer without preoperative radiotherapy.

Application of Transurethral Prostate Resection Instrumentation for Treating Low Rectal Anastomotic Leakage: A Pilot Study

“…Among the measures to treat anastomotic leakage, drainage is consistent, and its effect determines the development of the disease. 20–22 If the drainage effect is good, some patients can be exempted from receiving secondary diversion surgery, thus preserving anal function. The drainage path can be through the pelvis, through the anus, and through both the pelvis and anus.…”

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

“…The placement of the stent can allow the perforation to heal in an appropriate manner, which can effectively reduce the possibility of scarring and stenosis. Another advantage of the stent is that it can effectively prevent the development of a proximal intestinal diversion stoma[ 15 - 19 ]. TIDTs with balloons have a very good therapeutic effect in the prevention and treatment of anastomotic leakage.…”

“…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.…”

Endoluminal vacuum-assisted therapy as a treatment for anastomotic leakage in colorectal surgery

“…We believe that the use of a transanastomotic drainage tube (TDT) may be useful in preventing the onset of AL. Regarding the TDT, several studies showed no difference in AL rate between patients with and without one[ 31 ]. Other literature observations, instead, have documented a reduction in frequency of AL in patients with TDT[ 32 - 35 ].…”