[Continuous negative pressure-flush through extraperitoneal dual tube in the treatment and prevention for rectal cancer patients with anastomotic leakage after low anterior resection].

Abstract

To compare the efficacy between continuous negative pressure-flush through extraperitoneal dual tube and conventional drainage in the treatment and prevention for anastomotic leakage after low anterior resection in patients with rectal cancer. Clinical data of 627 rectal cancer patients undergoing low anterior resection by the same surgical team from January 2007 to March 2012 were reviewed retrospectively. Of 627 patients, 370 received self-made easy extraperitoneal dual tube which was placed in the dorsal site of an anastomosis for drainage (dual tube group), and the other 257 received conventional drainage tube from abdominal cavity (convention group) prophylactically. The incidence of postoperative anastomotic leakage, reoperation rate, drainage tube indwelling duration, hospitalization duration, hospitalization expense, quality of life score, incidence of anastomotic stricture within 6 months after operation were compared between the two groups. Anastomotic leakage after low Dixon operation was found in 25 cases (4.0%, 25/627), including 14 cases (3.8%, 14/370) in dual tube group, and 11 cases (4.3%, 11/257) in convention group, and the difference was not statistically significant. After anastomotic leakage occurrence, all the patients in dual tube group were managed by continuous negative pressure (50 mmHg)-flush through another self-made easy intra-rectal dual tube without reoperation, while 5 patients in conventional group underwent operation again because of treatment failure with continuous negative pressure-flush through intra-rectal dual tube for half a month. Drainage tube indwelling duration was (9.7±2.7) d and (16.4±3.6) d, hospitalization duration was (15.7±4.3) d and (21.5±6.4) d, hospitalization expenses was (42 470±3190) Yuan and (53 480±5630) Yuan in dual tube group and conventional group respectively, the differences were all statistically significant (all P<0.05). Quality of life on the 15th day of anastomotic leakage treatment was significantly better in dual tube group as compared to conventional group (P<0.05). Though continuous negative pressure-flush through extraperitoneal dual tube can not decrease the incidence of anastomotic leakage in rectal cancer patients after low anterior resection, it may increase the successful rate of conservative therapy, decrease the reoperation rate, and improve the quality of life when combined with the use of an intra-rectal dual tube.