The aim of this study was to assess the effect of transanal drainage (TD) tube (a Foley catheter) on the anastomotic leak (AL) rate after laparoscopic sphincter-saving surgery for rectal cancer (SSS).
A prospective study was conducted on, all consecutive patients undergoing SSS at our institution between June 2017 and October 2018. All patients had TD for at least 4 days after surgery and constituted the TD group. The patients from TD group were matched to patients who underwent SSS without TD between January 2015 and May 2017 (no-TD group) according to age, sex, body mass index, neoadjuvant radiochemotherapy, mesorectal excision (total vs partial), and type of anastomosis (stapled vs hand sewn and side-to-end versus end-to-end). The primary endpoint was the AL rate, including both clinical and radiological AL.
A total of 258 patients were included. Eighty-nine patients (34%) had a TD tube. After matching, 72 patients were included in each group. Mean TD duration was 3.9 [2.0–5.9] days. No significant differences between groups were observed in the rates of overall AL: 25/72 (35%) (TD) vs 17/72 (22%) (no-TD), (p = 0.14), clinical AL: 13/72 (18%) (TD) vs 7/72 (10%) (no-TD), (p = 0.23), and asymptomatic radiological AL: 12/72 (17%) (TD) vs 9/72 (13%) (no-TD), (p = 0.64). Multivariate analysis showed that male sex (OR 2.92, 95% CI [1.04–8.24]) and preoperative radiochemotherapy (OR 5.66, 95% CI [1.36–23.53]) were associated with AL.
Our case-matched study suggested that a TD tube does not reduce the AL rate after laparoscopic sphincter-saving surgery for rectal cancer.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Hain E, Manceau G, Maggiori L et al (2017) Bowel dysfunction after anastomotic leakage in laparoscopic sphincter-saving operative intervention for rectal cancer: a case-matched study in 46 patients using the Low Anterior Resection Score. Surgery 161:1028–1039
Hain E, Maggiori L, Manceau G et al (2017) Oncological impact of anastomotic leakage after laparoscopic mesorectal excision. Br J Surg 104:288–295
Wang S, Zhang Z, Liu M et al (2016) Efficacy of transanal tube placement after anterior resection for rectal cancer: a systematic review and meta-analysis. World J Surg Oncol 14:92
Wang F-G, Yan W-M, Yan M, Song M-M (2019) Comparison of anastomotic leakage rate and reoperation rate between transanal tube placement and defunctioning stoma after anterior resection: a network meta-analysis of clinical data. Eur J Surg Oncol 45:1301–1309
Bulow S, Bulut O, Christensen IJ et al (2006) Transanal stent in anterior resection does not prevent anastomotic leakage. Colorectal Dis 8:494–496
Maggiori L, Bretagnol F, Aslam MI et al (2014) Does pathologic response of rectal cancer influence postoperative morbidity after neoadjuvant radiochemotherapy and total mesorectal excision? Surgery 155:468–475
Kanso F, Maggiori L, Debove C et al (2015) Perineal or abdominal approach first during intersphincteric resection for low rectal cancer: which is the best strategy? Dis Colon Rectum 58:637–644
Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
R Core Team (2017). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/. Accessed 29 Feb 2000
Zhao W-T, Li N-N, He D, Feng J-Y (2017) Transanal tube for the prevention of anastomotic leakage after rectal cancer surgery: a systematic review and meta-analysis. World J Surg 41:267–276
Ha GW, Kim HJ, Lee MR (2015) Transanal tube placement for prevention of anastomotic leakage following low anterior resection for rectal cancer: a systematic review and meta-analysis. Ann Surg Treat Res 89:313
Chen H, Cai H-K, Tang Y-H (2018) An updated meta-analysis of transanal drainage tube for prevention of anastomotic leak in anterior resection for rectal cancer. Surg Oncol 27:333–340
Xiao L, Zhang W, Jiang P et al (2011) Can transanal tube placement after anterior resection for rectal carcinoma reduce anastomotic leakage rate? A single-institution prospective randomized study. World J Surg 35:1367–1377
Olsen BC, Sakkestad ST, Pfeffer F, Karliczek A (2019) Rate of anastomotic leakage after rectal anastomosis depends on the definition: pelvic abscesses are significant. Scand J Surg SJS Off Organ Finn Surg Soc Scand Surg Soc 108:241–249
Rullier, Laurent, Garrelon et al (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355–358
Matthiessen P, Hallböök O, Andersson M et al (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis Off J Assoc Coloproctol G B Irel 6:462–469
Wang L, Gu J (2010) Risk factors for symptomatic anastomotic leakage after low anterior resection for rectal cancer with 30 Gy/10 f/2 w preoperative radiotherapy. World J Surg 34:1080–1085
Matthiessen P, Hallböök O, Rutegard J et al (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246:207–214
Maggiori L, Bretagnol F, Lefèvre JH et al (2011) Conservative management is associated with a decreased risk of definitive stoma after anastomotic leakage complicating sphincter-saving resection for rectal cancer: conservative management is associated with a decreased risk of definitive stoma. Colorectal Dis 13:632–637
Hain E, Maggiori L, Manceau G et al (2016) Persistent asymptomatic anastomotic leakage after laparoscopic sphincter-saving surgery for rectal cancer: can diverting stoma be reversed safely at 6 months? Dis Colon Rectum 59:369–376
Hain E, Maggiori L, Laforest A et al (2019) Hospital stay for temporary stoma closure is shortened by C-reactive protein monitoring: a prospective case-matched study. Tech Coloproctol 23:453–459
Conflict of interest
The authors declare that they have no financial disclosure or conflict of interest.
This study was approved by our institutional review board, conducted according to the ethical standards of the Committee on Human Experimentation of our institution.
Informed consent was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Challine, A., Cazelles, A., Frontali, A. et al. Does a transanal drainage tube reduce anastomotic leakage? A matched cohort study in 144 patients undergoing laparoscopic sphincter-saving surgery for rectal cancer. Tech Coloproctol 24, 1047–1053 (2020). https://doi.org/10.1007/s10151-020-02265-y