Skip to main content
SpringerLink
Log in

Transanal drainage tube placement to prevent anastomotic leakage following colorectal cancer surgery with double stapling reconstruction

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

Anastomotic leakage (AL) is a critical complication of colorectal cancer surgery. The transanal drainage tube (TDT) is designed to prevent AL caused by decompression and stasis at the anastomosis. We conducted this study to investigate the feasibility of using the TDT to prevent AL following double-stapling technique reconstruction (DST).

Methods

The subjects of this study were 179 patients who underwent curative resection and DST reconstruction for sigmoid colon and rectal cancer in our institution between 2008 and 2013. We analyzed the effectiveness of the TDT for preventing AL.

Results

A TDT was placed in 78 patients (43.6 %, TDT group) and not placed in the remaining 101 patients (56.4 %, NTDT group). AL developed in 2 (2.6 %) patients from the TDT group and in 14 (13.9 %) patients from the NTDT group (p = 0.009). Univariate analysis revealed that AL was significantly correlated with tumor distance from the anal verge (AV), the number of staples, and TDT placement. Multivariate analysis revealed a significantly positive correlation between AL and AV [OR 0.877 (0.783–0.982) p = 0.023] and a significantly negative correlation between AL and TDT placement [OR 0.07 (0.013–0.374) p = 0.002].

Conclusions

Anastomotic decompression with TDT placement may prevent AL after colorectal cancer surgery with DST reconstruction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Carlsen E, Schlichting E, Guldvog I, Johnson E, Heald RJ. Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg. 1998;85:526–9.

    Article  CAS  PubMed  Google Scholar 

  2. Machado M, Hallbook O, Goldman S, Nystrom PO, Jarhult J, Sjodahl R. Defunctioning stoma in low anterior resection with colonic pouch for rectal cancer: a comparison between two hospitals with a different policy. Dis Colon Rectum. 2002;45:940–5.

    Article  PubMed  Google Scholar 

  3. Krarup PM, Jorgensen LN, Andreasen AH, Harling H, Danish Colorectal Cancer G. A nationwide study on anastomotic leakage after colonic cancer surgery. Colorectal Dis. 2012;14:e661–7.

    Article  PubMed  Google Scholar 

  4. Marra F, Steffen T, Kalak N, Warschkow R, Tarantino I, Lange J, et al. Anastomotic leakage as a risk factor for the long-term outcome after curative resection of colon cancer. Eur J Surg Oncol. 2009;35:1060–4.

    Article  CAS  PubMed  Google Scholar 

  5. Kube R, Mroczkowski P, Granowski D, Benedix F, Sahm M, Schmidt U, et al. Anastomotic leakage after colon cancer surgery: a predictor of significant morbidity and hospital mortality, and diminished tumour-free survival. Eur J Surg Oncol. 2010;36:120–4.

    Article  CAS  PubMed  Google Scholar 

  6. Buchs NC, Gervaz P, Secic M, Bucher P, Mugnier-Konrad B, Morel P. Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis. 2008;23:265–70.

    Article  PubMed  Google Scholar 

  7. Golub R, Golub RW, Cantu R Jr, Stein HD. A multivariate analysis of factors contributing to leakage of intestinal anastomoses. J Am Coll Surg. 1997;184:364–72.

    CAS  PubMed  Google Scholar 

  8. Krarup PM, Nordholm-Carstensen A, Jorgensen LN, Harling H. Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer: a nationwide cohort study. Ann Surg. 2014;259:930–8.

    Article  PubMed  Google Scholar 

  9. Nesbakken A, Nygaard K, Lunde OC. Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg. 2001;88:400–4.

    Article  CAS  PubMed  Google Scholar 

  10. Bell SW, Walker KG, Rickard MJ, Sinclair G, Dent OF, Chapuis PH, et al. Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg. 2003;90:1261–6.

    Article  CAS  PubMed  Google Scholar 

  11. Jung SH, Yu CS, Choi PW, Kim DD, Park IJ, Kim HC, et al. Risk factors and oncologic impact of anastomotic leakage after rectal cancer surgery. Dis Colon Rectum. 2008;51:902–8.

    Article  PubMed  Google Scholar 

  12. Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007;246:207–14.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Huser N, Michalski CW, Erkan M, Schuster T, Rosenberg R, Kleeff J, et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg. 2008;248:52–60.

    Article  PubMed  Google Scholar 

  14. Tan WS, Tang CL, Shi L, Eu KW. Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg. 2009;96:462–72.

    Article  CAS  PubMed  Google Scholar 

  15. Schmidt O, Merkel S, Hohenberger W. Anastomotic leakage after low rectal stapler anastomosis: significance of intraoperative anastomotic testing. Eur J Surg Oncol. 2003;29:239–43.

    Article  CAS  PubMed  Google Scholar 

  16. Xiao L, Zhang WB, Jiang PC, Bu XF, Yan Q, Li H, et al. Can transanal tube placement after anterior resection for rectal carcinoma reduce anastomotic leakage rate? A single-institution prospective randomized study. World J Surg. 2011;35:1367–77.

    Article  PubMed  Google Scholar 

  17. Zhao WT, Hu FL, Li YY, Li HJ, Luo WM, Sun F. Use of a transanal drainage tube for prevention of anastomotic leakage and bleeding after anterior resection for rectal cancer. World J Surg. 2013;37:227–32.

    Article  PubMed  Google Scholar 

  18. Nishigori H, Ito M, Nishizawa Y, Nishizawa Y, Kobayashi A, Sugito M, et al. Effectiveness of a transanal tube for the prevention of anastomotic leakage after rectal cancer surgery. World J Surg. 2014;38:1843–51.

    Article  PubMed  Google Scholar 

  19. Yamamoto S, Watanabe M, Hasegawa H, Kitajima M. Oncologic outcome of laparoscopic versus open surgery for advanced colorectal cancer. Hepatogastroenterology. 2001;48:1248–51.

    CAS  PubMed  Google Scholar 

  20. Yamamoto S, Watanabe M, Hasegawa H, Baba H, Kitajima M. Short-term surgical outcomes of laparoscopic colonic surgery in octogenarians: a matched case-control study. Surg Laparosc Endosc Percutan Tech. 2003;13:95–100.

    Article  PubMed  Google Scholar 

  21. Hasegawa H, Ishii Y, Nishibori H, Endo T, Watanabe M, Kitajima M. Short- and midterm outcomes of laparoscopic surgery compared for 131 patients with rectal and rectosigmoid cancer. Surg Endosc. 2007;21:920–4.

    Article  CAS  PubMed  Google Scholar 

  22. Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol. 2012;17:1–29.

    Article  PubMed  Google Scholar 

  23. Owens WD, Felts JA, Spitznagel EL Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978;49:239–43.

    Article  CAS  PubMed  Google Scholar 

  24. Sterk P, Schubert F, Gunter S, Klein P. Anastomotic protection with a transanal tube after rectum resection and total mesorectal excision. Zentralbl Chir. 2001;126:601–4.

    Article  CAS  PubMed  Google Scholar 

  25. Patrascu T, Doran H, Musat O. Protective transanal tube in colo-rectal anastomosis. Chirurgia (Bucur). 2004;99:75–8.

    Google Scholar 

  26. Cong ZJ, Fu CG, Wang HT, Liu LJ, Zhang W, Wang H. Influencing factors of symptomatic anastomotic leakage after anterior resection of the rectum for cancer. World J Surg. 2009;33:1292–7.

    Article  PubMed  Google Scholar 

  27. Fujita F, Torashima Y, Kuroki T, Eguchi S. The risk factors and predictive factors for anastomotic leakage after resection for colorectal cancer: reappraisal of the literature. Surg Today. 2014;44:1595–602.

    Article  PubMed  Google Scholar 

  28. Yao HH, Shao F, Huang Q, Wu Y, Qiang Zhu Z, Liang W. Nomogram to predict anastomotic leakage after laparoscopic anterior resection with intracorporeal rectal transection and double-stapling technique anastomosis for rectal cancer. Hepatogastroenterology. 2014;61:1257–61.

    Google Scholar 

  29. Hinoi T, Okajima M, Shimomura M, Egi H, Ohdan H, Konishi F, et al. Effect of left colonic artery preservation on anastomotic leakage in laparoscopic anterior resection for middle and low rectal cancer. World J Surg. 2013;37:2935–43.

    Article  PubMed  Google Scholar 

  30. Matsuda K, Hotta T, Takifuji K, Yokoyama S, Oku Y, Watanabe T, et al. Randomized clinical trial of defaecatory function after anterior resection for rectal cancer with high versus low ligation of the inferior mesenteric artery. Br J Surg. 2015;102:501–8.

    Article  CAS  PubMed  Google Scholar 

  31. Kawada K, Hasegawa S, Hida K, Hirai K, Okoshi K, Nomura A, et al. Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis. Surg Endosc. 2014;28:2988–95.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Lolis ED, Theodoridou E, Vogiatzis N, Neonaki D, Markakis C, Daskalakis K. The safety of primary repair or anastomosis in high-risk trauma patients. Surg Today. 2015;45:730–9.

    Article  PubMed  Google Scholar 

  33. Rondelli F, Balzarotti R, Bugiantella W, Mariani L, Pugliese R, Mariani E. Temporary percutaneous ileostomy versus conventional loop ileostomy in mechanical extraperitoneal colorectal anastomosis: a retrospective study. Eur J Surg Oncol. 2012;38:1065–70.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

      Mutsuhito Matsuda, Masashi Tsuruta, Hirotoshi Hasegawa, Koji Okabayashi, Takayuki Kondo, Takehiro Shimada, Masashi Yahagi, Yusuke Yoshikawa & Yuko Kitagawa

    Authors
    1. Mutsuhito Matsuda
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Masashi Tsuruta
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Hirotoshi Hasegawa
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Koji Okabayashi
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Takayuki Kondo
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Takehiro Shimada
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Masashi Yahagi
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Yusuke Yoshikawa
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Yuko Kitagawa
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Masashi Tsuruta.

    Ethics declarations

    Conflict of interest

    Mutsuhito Matsuda and his co-authors have no conflicts of interest.

    Additional information

    M. Matsuda and M. Tsuruta contributed equally to this article.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Matsuda, M., Tsuruta, M., Hasegawa, H. et al. Transanal drainage tube placement to prevent anastomotic leakage following colorectal cancer surgery with double stapling reconstruction. Surg Today 46, 613–620 (2016). https://doi.org/10.1007/s00595-015-1230-3

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00595-015-1230-3

    Keywords

    Search

    Navigation