Skip to main content
SpringerLink
Log in

Does a transanal drainage tube reduce anastomotic leakage? A matched cohort study in 144 patients undergoing laparoscopic sphincter-saving surgery for rectal cancer

Techniques in Coloproctology volume 24, pages 1047–1053 (2020)Cite this article

Abstract

Background

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).

Methods

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.

Results

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.

Conclusions

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.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

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

References

  1. 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

    Article  Google Scholar 

  2. Hain E, Maggiori L, Manceau G et al (2017) Oncological impact of anastomotic leakage after laparoscopic mesorectal excision. Br J Surg 104:288–295

    Article  CAS  Google Scholar 

  3. 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

  4. 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

    Article  Google Scholar 

  5. Bulow S, Bulut O, Christensen IJ et al (2006) Transanal stent in anterior resection does not prevent anastomotic leakage. Colorectal Dis 8:494–496

    Article  CAS  Google Scholar 

  6. 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

    Article  Google Scholar 

  7. 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

    Article  Google Scholar 

  8. 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

    Article  Google Scholar 

  9. 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

  10. 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

    Article  Google Scholar 

  11. 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

    Article  Google Scholar 

  12. 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

    Article  Google Scholar 

  13. 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

    Article  Google Scholar 

  14. 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

    CAS  Google Scholar 

  15. Rullier, Laurent, Garrelon et al (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355–358

    Article  CAS  Google Scholar 

  16. 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

    CAS  Google Scholar 

  17. 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

    Article  Google Scholar 

  18. 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

    Article  Google Scholar 

  19. 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

    Article  CAS  Google Scholar 

  20. 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

    Article  Google Scholar 

  21. 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

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service de Chirurgie Colorectale, Pôle des Maladies de l’Appareil Digestif, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, 100 Boulevard du Général Leclerc, 92118, Clichy Cedex, France

    A. Challine, A. Cazelles, A. Frontali, L. Maggiori & Y. Panis

Authors
  1. A. Challine
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Cazelles
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Frontali
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Maggiori
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Y. Panis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Y. Panis.

Ethics declarations

Conflict of interest

The authors declare that they have no financial disclosure or conflict of interest.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-020-02265-y

Keywords

search

Navigation