There is increasing evidence that either a transanal stent (TAS) or rectal tube (RT) can decrease the risk of anastomotic leakage (AL) after anterior resection for rectal cancer, in which a diverting stoma may not be required.
The aim of this review was to investigate the efficacy and safety of RT/TAS in preventing AL after anterior resections.
An up-to-date systematic review was performed on the available literature between 2000 and 2020 on PubMed, EMBASE, Medline and Cochrane Library databases.
All studies reporting on anterior resections in adults, comparing transanal tube/stent versus non-tube/stent, were analysed.
Main outcome measure
The primary outcome was rates of AL, whereas secondary outcomes compared associated unplanned re-operation for AL and hospital length of stay (LOS).
Two randomized controlled trials and 13 observational studies were included, with 1714 patients receiving RT/TAS and 1741 patients without. There were 119 (7%) patients with AL in the RT/TAS group compared to 216 (12.3%) patients in the non-RT/TAS group (OR: 0.48, 95% CI: 0.38–0.62, p < 0.001). There were 47 (2.9%) patients with AL complications requiring surgery in the RT/TAS group compared to 132 (8%) patients in the non-RT/TAS group (OR: 0.29, 95% CI: 0.20–0.42, p < 0.001) and no significant difference identified with the standardized mean difference (SMD) favouring the RT/TAS group for hospital LOS (SMD: −0.23, 95% CI: −0.51 to 0.06, p = 0.115).
The use of RT/TAS post restorative anterior resection for rectal cancer should be considered, given the benefits shown from this meta-analysis.
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Rawla P, Sunkara T, Barsouk A (2019) Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Przegla̜d Gastroenterol 14(2):89
Glynne-Jones R, Mathur P, Elton C, Train ML (2007) Multimodal treatment of rectal cancer. Best Pract Res Clin Gastroenterol 21(6):1049–1070
Heald R (2013) A new solution to some old problems: transanal TME. Springer
Choi G-S, Park IJ, Kang BM, Lim KH, Jun S-H (2009) A novel approach of robotic-assisted anterior resection with transanal or transvaginal retrieval of the specimen for colorectal cancer. Surg Endosc 23(12):2831–2835
Wang S, Zhang Z, Liu M, Li S, Jiang C (2016) Efficacy of transanal tube placement after anterior resection for rectal cancer: a systematic review and meta-analysis. World J Surg Oncol 14(1):1–6
Morks AN, Havenga K, Ploeg RJ (2011) Can intraluminal devices prevent or reduce colorectal anastomotic leakage: a review. World J Gastroenterol: WJG 17(40):4461–4469
Shigeta K, Okabayashi K, Baba H, Hasegawa H, Tsuruta M, Yamafuji K, Kubochi K, Kitagawa Y (2016) A meta-analysis of the use of a transanal drainage tube to prevent anastomotic leakage after anterior resection by double-stapling technique for rectal cancer. Surg Endosc 30(2):543–550
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(1):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(6):313–318
Ptok H, Marusch F, Meyer F, Schubert D, Gastinger I, Lippert H (2007) Impact of anastomotic leakage on oncological outcome after rectal cancer resection. Br J Surg 94(12):1548–1554
Law WL, Choi HK, Lee YM, Ho JW, Seto CL (2007) Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg 11(1):8–15
Wong N, Eu K (2005) A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective, comparative study. Dis Colon Rectum 48(11):2076–2079
Amin A, Ramalingam T, Sexton R, Heald R, Leppington-Clarke A, Moran B (2003) Comparison of transanal stent with defunctioning stoma in low anterior resection for rectal cancer. Br J Surg 90(5):581–582
Jurt J, Slieker J, Frauche P, Addor V, Solà J, Demartines N, Hübner M (2017) Enhanced recovery after surgery: can we rely on the key factors or do we need the bel ensemble? World J Surg 41(10):2464–2470
Yang Y, Shu Y, Su F, Xia L, Duan B, Wu X (2017) 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(4):1513–1523
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(3):333–340
Bülow S, Bulut O, Christensen IJ, Harling H, Group RSS (2006) Transanal stent in anterior resection does not prevent anastomotic leakage. Color Dis 8(6):494–496
Xiao L, Zhang W-b, Jiang P-c, Bu X-f, Yan Q, Li H 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(6):1367
Carboni F, Valle M, Sandri GBL, Giofrè M, Federici O, Zazza S et al (2020) Transanal drainage tube: alternative option to defunctioning stoma in rectal cancer surgery? Transl Gastroenterol Hepatol 5
Kawada K, Takahashi R, Hida K, Sakai Y (2018) Impact of transanal drainage tube on anastomotic leakage after laparoscopic low anterior resection. Int J Color Dis 33(3):337–340
Goto S, Hida K, Kawada K, Okamura R, Hasegawa S, Kyogoku T, Ota S, Adachi Y, Sakai Y (2017) Multicenter analysis of transanal tube placement for prevention of anastomotic leak after low anterior resection. J Surg Oncol 116(8):989–995
Ito T, Obama K, Sato T, Matsuo K, Inoue H, Kubota K, Tamaki N, Kami K, Yoshimura N, Shono T, Yamamoto E, Morimoto T (2017) Usefulness of transanal tube placement for prevention of anastomotic leakage following laparoscopic low anterior resection. Asian J Endosc Surg 10(1):17–22
Brandl A, Czipin S, Mittermair R, Weiss S, Pratschke J, Kafka-Ritsch R (2016) Transanal drainage tube reduces rate and severity of anastomotic leakage in patients with colorectal anastomosis: a case controlled study. Ann Med Surg 6:12–16
Matsuda M, Tsuruta M, Hasegawa H, Okabayashi K, Kondo T, Shimada T, Yahagi M, Yoshikawa Y, Kitagawa Y (2016) Transanal drainage tube placement to prevent anastomotic leakage following colorectal cancer surgery with double stapling reconstruction. Surg Today 46(5):613–620
Yang CS, Choi GS, Park J, Park S, Kim H, Choi JI et al (2016) Rectal tube drainage reduces major anastomotic leakage after minimally invasive rectal cancer surgery. Color Dis 18(12):O445–OO52
Hidaka E, Ishida F, Mukai S, Nakahara K, Takayanagi D, Maeda C, Takehara Y, Tanaka JI, Kudo SE (2015) Efficacy of transanal tube for prevention of anastomotic leakage following laparoscopic low anterior resection for rectal cancers: a retrospective cohort study in a single institution. Surg Endosc 29(4):863–867
Kim M-K, Won D-Y, Lee J-K, Kang W-K, Kim J-G, Oh ST (2015) Comparative study between transanal tube and loop ileostomy in low anterior resection for mid rectal cancer: a retrospective single center trial. Ann Surg Treat Res 88(5):260–268
Lee SY, Kim CH, Kim YJ, Kim HR (2015) Impact of anal decompression on anastomotic leakage after low anterior resection for rectal cancer: a propensity score matching analysis. Langenbeck’s Arch Surg 400(7):791–796
Adamova Z (2014) Transanal tube as a means of prevention of anastomotic leakage after rectal cancer surgery. Visceral Med 30(6):422–426
Nishigori H, Ito M, Nishizawa Y, Nishizawa Y, Kobayashi A, Sugito M, Saito N (2014) Effectiveness of a transanal tube for the prevention of anastomotic leakage after rectal cancer surgery. World J Surg 38(7):1843–1851
Zhao W-T, Hu F-L, Li Y-Y, Li H-J, Luo W-M, Sun F (2013) Use of a transanal drainage tube for prevention of anastomotic leakage and bleeding after anterior resection for rectal cancer. World J Surg 37(1):227–232
Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, Holm T, Wong WD, Tiret E, Moriya Y, Laurberg S, den Dulk M, van de Velde C, Büchler MW (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 147(3):339–351
Walker KG, Bell SW, Rickard MJ, Mehanna D, Dent OF, Chapuis PH et al (2004) Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 240(2):255–259
Lu ZR, Rajendran N, Lynch AC, Heriot AG, Warrier SK (2016) Anastomotic leaks after restorative resections for rectal cancer compromise cancer outcomes and survival. Dis Colon Rectum 59(3):236–244
Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P (2011) Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 253(5):890–899
Baskaranathan S, Philips J, McCredden P, Solomon MJ (2004) Free colorectal cancer cells on the peritoneal surface: correlation with pathologic variables and survival. Dis Colon Rectum 47(12):2076–2079
Bohle B, Pera M, Pascual M, Alonso S, Mayol X, Salvado M, Schmidt J, Grande L (2010) Postoperative intra-abdominal infection increases angiogenesis and tumor recurrence after surgical excision of colon cancer in mice. Surgery. 147(1):120–126
Sammour T, Hayes IP, Jones IT, Steel MC, Faragher I, Gibbs P (2018) Impact of anastomotic leak on recurrence and survival after colorectal cancer surgery: a BioGrid Australia analysis. ANZ J Surg 88(1–2):E6–E10
Montemurro S, De Luca R, Caliandro C, Ruggieri E, Rucci A, Sciscio V et al (2012) Transanal tube NO COIL® after rectal cancer proctectomy. The “G. Paolo II” Cancer Centre experience. Tumori J 98(5):607–614
Phan K, Oh L, Ctercteko G, Pathma-Nathan N, El Khoury T, Azam H et al (2019) Does a stoma reduce the risk of anastomotic leak and need for re-operation following low anterior resection for rectal cancer: systematic review and meta-analysis of randomized controlled trials. J Gastrointest Oncol 10(2):179–187
Gurjar S, Forshaw M, Ahktar N, Stewart M, Parker M (2007) Indwelling trans-anastomotic rectal tubes in colorectal surgery: a survey of usage in UK and Ireland. Color Dis 9(1):47–51
Pędziwiatr M, Mavrikis J, Witowski J, Adamos A, Major P, Nowakowski M, Budzyński A (2018) Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery. Med Oncol 35(6):95
Helander EM, Webb MP, Bias M, Whang EE, Kaye AD, Urman RD (2017) A comparison of multimodal analgesic approaches in institutional enhanced recovery after surgery protocols for colorectal surgery: pharmacological agents. J Laparoendosc Adv Surg Tech 27(9):903–908
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Choy, K.T., Yang, T.W.W., Heriot, A. et al. Does rectal tube/transanal stent placement after an anterior resection for rectal cancer reduce anastomotic leak? A systematic review and meta-analysis. Int J Colorectal Dis (2021). https://doi.org/10.1007/s00384-021-03851-8
- Anterior resection
- Rectal tube
- Anastomotic leak