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Prophylactic transanal decompression tube versus non-prophylactic transanal decompression tube for anastomotic leakage prevention in low anterior resection for rectal cancer: a meta-analysis

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Abstract

Background

Transanal decompression tube (TDT), an alternative intervention believed to have potential equivalent efficacy in reducing anastomotic leakage after rectal cancer surgery and lower complication rates compared to protective stoma, was sporadically applied in some medical centers during recent decade. The objective of this meta-analysis was to evaluate the effect of the TDT in preventing the anastomotic leakage after low anterior resection for rectal cancer.

Methods

The studies comparing TDT and non-TDT in rectal cancer were researched up to March 22, 2016 without language preference, in databases of PubMed, Web of Science, Cochrane library, International Clinical Trials Registry Platform, and National Clinical Trials Registry. The rates of anastomotic leakage, bleeding, and re-operation were separately calculated and compared between TDT and non-TDT groups using RevMan 5.3. Funnel plots, and Egger’s tests were used to evaluate the publication biases of the studies.

Results

Two prospective randomized controlled trial studies and five observational cohort studies with 833 participants in TDT group and 939 participants in non-TDT group were finally included in this meta-analysis. The results indicated that the TDT group had lower anastomotic leakage rate than non-TDT group with significant RR (RR 0.44; 95 % CI 0.29–0.66; P < 0.0001) and heterogeneity (I 2 = 33 %; P = 0.18). So did the re-operation rate, with RR (RR 0.16; 95 % CI 0.07–0.37; P < 0.0001) and heterogeneity among the studies (I 2 = 0 %; P = 0.80). There was no significant difference in anastomotic bleeding rates (RR 1.48; 95 % CI 0.79–2.77; P = 0.22) (I 2 = 58 %; P = 0.09). No publication bias was found by Egger’s test (anastomotic leakage rate, Pr > |z| = 0.224; re-operation rate, Pr > |z| = 0.425).

Conclusions

TDT might be an efficient and economic intervention in preventing anastomotic leakage after rectal cancer surgery.

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Acknowledgments

The authors thank all colleagues of the Colorectal Group for clinical suggestions and Dr. Zhaohui Yang from University of Florida for reading and commenting the manuscript.

Authors’ contributions

Y.Y. and Y.S. played equal role in data analysis and interpretation, drafting and revising the article critically for important intellectual content. F.S. the statistical expertise, played role in data analysis and revising article critically for important intellectual content. L.X. played role in data acquisition. B.D. played role in data verification and proof read. X.W. played role in the conception and design of the study and final approval of the version to be submitted.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, West China School of Medicine, Sichuan University/West China Hospital, Chengdu Shangjin Nanfu, Chengdu, 610041, Sichuan Province, China

    Yun Yang

  2. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Lane, Chengdu, 610041, Sichuan Province, China

    Ye Shu, Lin Xia & Xiaoting Wu

  3. Department of Epidemiology, University of Florida, Gainesville, FL, USA

    Fangyu Su

  4. Department of Oncology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China

    Baofeng Duan

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  1. Yun Yang
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  4. Lin Xia
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Correspondence to Xiaoting Wu.

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Dr. Yun Yang and Dr. Ye Shu report, in addition, they have a patent “A New-type Anatomical Transanal Decompression Tube” licensed to ZL201410524545.2. Dr. Lin Xia, Dr. Baofeng Duan, Dr. Xiaoting Wu, and Mr. Fangyu Su declare that they have no conflict of interest.

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Yang, Y., Shu, Y., Su, F. et al. Prophylactic transanal decompression tube versus non-prophylactic transanal decompression tube for anastomotic leakage prevention in low anterior resection for rectal cancer: a meta-analysis. Surg Endosc 31, 1513–1523 (2017). https://doi.org/10.1007/s00464-016-5193-2

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