Does rectal tube/transanal stent placement after an anterior resection for rectal cancer reduce anastomotic leak? A systematic review and meta-analysis

Abstract

Background

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.

Objectives

The aim of this review was to investigate the efficacy and safety of RT/TAS in preventing AL after anterior resections.

Data sources

An up-to-date systematic review was performed on the available literature between 2000 and 2020 on PubMed, EMBASE, Medline and Cochrane Library databases.

Study selection

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).

Results

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).

Conclusion

The use of RT/TAS post restorative anterior resection for rectal cancer should be considered, given the benefits shown from this meta-analysis.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. 1.

    Rawla P, Sunkara T, Barsouk A (2019) Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Przegla̜d Gastroenterol 14(2):89

    CAS  Google Scholar 

  2. 2.

    Glynne-Jones R, Mathur P, Elton C, Train ML (2007) Multimodal treatment of rectal cancer. Best Pract Res Clin Gastroenterol 21(6):1049–1070

    PubMed  Article  PubMed Central  Google Scholar 

  3. 3.

    Heald R (2013) A new solution to some old problems: transanal TME. Springer

  4. 4.

    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

    PubMed  Article  PubMed Central  Google Scholar 

  5. 5.

    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

    CAS  Article  Google Scholar 

  6. 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

    PubMed  Article  PubMed Central  Google Scholar 

  7. 7.

    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

    PubMed  Article  Google Scholar 

  8. 8.

    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

    PubMed  Article  Google Scholar 

  9. 9.

    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

    PubMed  PubMed Central  Article  Google Scholar 

  10. 10.

    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

    CAS  PubMed  Article  Google Scholar 

  11. 11.

    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

    PubMed  Article  Google Scholar 

  12. 12.

    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

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    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

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    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

    PubMed  Article  Google Scholar 

  15. 15.

    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

    PubMed  Article  Google Scholar 

  16. 16.

    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

    PubMed  Article  Google Scholar 

  17. 17.

    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

    Article  Google Scholar 

  18. 18.

    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

    PubMed  Article  Google Scholar 

  19. 19.

    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

  20. 20.

    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

    Article  Google Scholar 

  21. 21.

    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

    PubMed  Article  Google Scholar 

  22. 22.

    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

    PubMed  Article  Google Scholar 

  23. 23.

    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

    CAS  Article  Google Scholar 

  24. 24.

    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

    PubMed  Article  Google Scholar 

  25. 25.

    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

    Article  Google Scholar 

  26. 26.

    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

    PubMed  Article  Google Scholar 

  27. 27.

    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

    PubMed  PubMed Central  Article  Google Scholar 

  28. 28.

    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

    Article  Google Scholar 

  29. 29.

    Adamova Z (2014) Transanal tube as a means of prevention of anastomotic leakage after rectal cancer surgery. Visceral Med 30(6):422–426

    Article  Google Scholar 

  30. 30.

    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

    PubMed  Article  Google Scholar 

  31. 31.

    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

    PubMed  Article  Google Scholar 

  32. 32.

    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

    PubMed  Article  Google Scholar 

  33. 33.

    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

    PubMed  PubMed Central  Article  Google Scholar 

  34. 34.

    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

    PubMed  Article  Google Scholar 

  35. 35.

    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

    PubMed  Article  Google Scholar 

  36. 36.

    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

    PubMed  Article  Google Scholar 

  37. 37.

    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

    PubMed  Article  Google Scholar 

  38. 38.

    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

    PubMed  Article  Google Scholar 

  39. 39.

    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

    Article  Google Scholar 

  40. 40.

    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

    PubMed  PubMed Central  Article  Google Scholar 

  41. 41.

    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

    CAS  Article  Google Scholar 

  42. 42.

    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

    PubMed  PubMed Central  Article  Google Scholar 

  43. 43.

    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

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Contributions

Substantial contributions to the conception and design, acquisition of data or analysis and interpretation of data: All authors

Drafting and revising the article: All authors

Final approval of the version to be published: All authors

Corresponding author

Correspondence to Kay T. Choy.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

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

KTC and TWWY are co-first authors.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

Keywords

  • Anterior resection
  • Rectal tube
  • Decompression
  • Anastomotic leak