Multicenter analysis of transanal tube placement for prevention of anastomotic leak after low anterior resection

Goto, Saori; Hida, Koya; Kawada, Kenji; Okamura, Ryosuke; Hasegawa, Suguru; Kyogoku, Takahisa; Ota, Shuichi; Adachi, Yoshifumi; Sakai, Yoshiharu

doi:10.1002/jso.24760

Cited by 33 publications

(28 citation statements)

References 29 publications

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“…Several previous studies have identified the efficacy of transanal drainage tube placement in preventing anastomotic fistula. [16,20–23] Placing the drainage tube in the anus-intestinal cavity and keeping it unobstructed to reduce the intestinal pressure, which is an important means to reduce the incidence of the complications related to TME. The method of implementation is still up to the surgeon to decide, mainly depending on experience, patient characteristics, and the operation environment, rather than any clear evidence that one technique is superior to another.…”

Section: Introductionmentioning

confidence: 99%

Application of the cuff rectum drainage tube in total mesorectal excision for low rectal cancer

Zhu

Liu

et al. 2019

Medicine

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To investigate therapeutic effect of cuff rectum drainage tube (CDT) in preventing the postoperative complications of total mesorectal excision (TME) and promoting the recovery of the patients. The clinical data of 84 cases of low rectal cancer performed TME from June 2015 to June 2017 in the First Affiliated Hospital of Xiamen University were analyzed retrospectively. All the cases were performed anus-retained operation without preventive colostomy. Patients were divided into 2 groups according to the material of the anorectal drainage tube placed in the colonic cavity. Group I (CDT group) was transanal cuff rectal drainage tube placement (Patent No. ZL 201320384337.8) (n = 48), and group II (conventional group) was transanal clinical conventional drainage tube placement (n = 36). Anastomotic fistula incidence, the time of anal exsufflation, postoperative first ambulation time, intestinal function recovery time, the incidence of interrelated complications of drainage tube and postoperative hospital stay between 2 groups were analyzed retrospectively. Both postoperative first ambulation and anal exhaust time in CDT group were shorter than those in the conventional group ([2.3 ± 0.4] d vs [3.0 ± 0.2] d, P < .05; [3.3 ± 0.3] d vs [3.9 ± 0.5] d, P < .05). Meanwhile, the postoperative hospital stay of CDT group was significantly decreased than that in the conventional group ([10.3 ± 1.6] d vs [11.8 ± 1.1] d, P < .05). Significant different occurrence of complications existed in anastomotic fistula (2.1% [1/48] vs 16.7% [6/36], P < .05), frequent defecation (8.3% [4/48] vs 27.8% [10/36], P < .05), defecating unfinished feeling (12.5% [6/48] vs 30.6% [11/36], P < .05), drainage tube complication (4.2% [2/48] vs 22.2% [8/36], P < .05). The cuff rectum drainage tube may reduce incidence of anastomotic fistula after TME, shorten postoperative first ambulation and anal exsufflation time, enable faster recovery with good toleration and decrease postoperative hospital stay.

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Section: Introductionmentioning

confidence: 99%

Application of the cuff rectum drainage tube in total mesorectal excision for low rectal cancer

Zhu

Liu

et al. 2019

Medicine

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“…However, it requires the second operation for reimbursement, which not only brings inconvenience to the postoperative life of patients but also increases the pain of the second operation. Many studies have suggested that TDT is effective in reducing AL [8][9][10][11][12][13][19][20][21][22]. In recent years, it has become a routine practice to retain TDT to prevent AL after the operation.…”

Section: Discussionmentioning

confidence: 99%

“…The use of TDT also has some common disadvantages, such as anus discomfort symptoms, soreness of the perianal skin, etc. In addition, TDT can make early out-of-bed activities inconvenient for patients, which may increase patients' bedtime and increase the risk of thrombosis [12], and it even reported that TDT may have association with bowel perforation [12,22]. Is it possible that TDT is too deep or the diameter of the tube is too large?…”

Section: Discussionmentioning

confidence: 99%

“…In 1997, Klein et al proposed that TDT is an effective method to prevent the AL [7]. Many prospective studies and meta-analysis results show that the indentation of TDT can prevent and reduce the incidence of anastomotic leakage [8][9][10][11][12][13]. Transanal tube placement to prevent AL has become a routine choice for surgeons in recent years, but there is no uniform type of TDT in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Effect comparison of three different types of transanal drainage tubes after anterior resection for rectal cancer

Luo

Zhu

et al. 2020

BMC Surg

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Background: Anastomotic leakage (AL) is one of the most severe early complications after rectal cancer surgery. Many studies and meta-analysis results show that the indentation of transanal drainage tubes (TDT) can prevent and reduce the incidence of AL. However, the size and material of drainage tubes are rarely reported. Herein, we compare the effect of three kinds of TDT and analyze the use of TDT material and size to prevent AL, which may better prevent the occurrence of AL. Methods: The clinical data of 182 patients who underwent laparoscopic anterior resection of rectal cancer were retrospectively analyzed between January 2016 and March 2019. According to the types of indwelling TDT after the operation, they were divided into Fr32 silicone tubes (81 cases), Fr24 silicone tubes (54 cases), Fr24 latex tubes (47 cases). The first drainage, exhaust, defecation, abdominal distension and anastomotic leakage of the patients with three different types of TDT were compared. Results: There was no significant difference in the degree of first exhaust, abdominal distension and anastomotic leakage among three different types of TDT; the time of first drainage and defecation of the Fr32 silicone tube was significantly earlier than that of Fr24 silicone tube and Fr24 latex tube. Conclusion: The drainage effect of the Fr32 silicone tube is better than that of Fr24 silicone tube and Fr24 latex tube after anterior resection for rectal cancer, Fr32 silicone may better prevent the occurrence of AL, but randomized controlled studies are needed.

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“…Previous reports have indicated that male sex, history of smoking and ischemic heart disease, tumor location and size, malnutrition, and intersections of staple lines are possible factors that can lead to AL in rectal tumor patients[10,15-18]. Prophylactic ileostomy, transanal tube placement, and intracorporeal reinforcing sutures may decrease the incidence of AL[19,20]. Additionally, some assay indexes and prediction models have been established to evaluate the possibility of AL[21-23].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative intraperitoneal chemotherapy increases the incidence of anastomotic leakage after anterior resection of rectal tumors

Wang¹,

Tao²,

Chen³

et al. 2019

WJGO

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BACKGROUND Intraoperative intraperitoneal chemotherapy is an emerging treatment modality for locally advanced rectal neoplasms. However, its impacts on postoperative complications remain unknown. Anastomotic leakage (AL) is one of the most common and serious complications associated with the anterior resection of rectal tumors. Therefore, we designed this study to determine the effects of intraoperative intraperitoneal chemotherapy on AL. AIM To investigate whether intraoperative intraperitoneal chemotherapy increases the incidence of AL after the anterior resection of rectal neoplasms. METHODS This retrospective cohort study collected information from 477 consecutive patients who underwent an anterior resection of rectal carcinoma using the double stapling technique at our institution from September 2016 to September 2017. Based on the administration of intraoperative intraperitoneal chemotherapy or not, the patients were divided into a chemotherapy group (171 cases with intraperitoneal implantation of chemotherapy agents during the operation) or a control group (306 cases without intraoperative intraperitoneal chemotherapy). Clinicopathologic features, intraoperative treatment, and postoperative complications were recorded and analyzed to determine the effects of intraoperative intraperitoneal chemotherapy on the incidence of AL. The clinical outcomes of the two groups were also compared through survival analysis. RESULTS The univariate analysis showed a significantly higher incidence of AL in the patients who received intraoperative intraperitoneal chemotherapy, with 13 (7.6%) cases in the chemotherapy group and 5 (1.6%) cases in the control group ( P = 0.001). As for the severity of AL, the AL patients who underwent intraoperative intraperitoneal chemotherapy tended to be more severe cases, and 12 (92.3%) out of 13 AL patients in the chemotherapy group and 2 (40.0%) out of 5 AL patients in the control group required a secondary operation ( P = 0.044). A multivariate analysis was subsequently performed to adjust for the confounding factors and also showed that intraoperative intraperitoneal chemotherapy increased the incidence of AL (odds ratio = 5.386; 95%CI: 1.808-16.042; P = 0.002). However, the survival analysis demonstrated that intraoperative intraperitoneal chemotherapy could also improve the disease-free survival rates for patients with locally advanced rectal cancer. CONCLUSION Intraoperative intraperitoneal chemotherapy can improve the prognosis of patients with locally advanced rectal carcinoma, but it also increases the risk of AL following the anterior resection of rectal neoplasms.

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Multicenter analysis of transanal tube placement for prevention of anastomotic leak after low anterior resection

Abstract: Transanal tube placement is effective for decreasing the incidence of symptomatic AL after LAR.

Cited by 33 publications

References 29 publications

Application of the cuff rectum drainage tube in total mesorectal excision for low rectal cancer

Application of the cuff rectum drainage tube in total mesorectal excision for low rectal cancer

Effect comparison of three different types of transanal drainage tubes after anterior resection for rectal cancer

Intraoperative intraperitoneal chemotherapy increases the incidence of anastomotic leakage after anterior resection of rectal tumors

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