Efficacy and Safety of Transanal Tube Drainage for Prevention of Anastomotic Leakage Following Laparoscopic Low Anterior Resection for Rectal Cancers

Abstract

Introduction: Laparoscopic surgery is widely used for the treatment of colorectal cancer. But anastomotic leakage is one of the most serious complications following laparoscopic low anterior resection (LAR) for rectal cancer. The purpose of this study was to investigate whether transanal drainage tube placement can reduce anastomotic leakage and avoid re-operation after laparoscopic LAR. Methods: Retrospective assessment was performed on 143 patients with rectal cancers who underwent laparoscopic LAR between April 2009 and March 2016. A diverting stoma was not created in all 143 patients. A transanal drainage tube was placed after anastomosis using a double stapling technique, in 90 patients (group TT). In group TT, a 24 Fr. Silicon catheter was inserted into the anus and was placed approximately 20 - 25 cm in the descending colon. Another 53 patients were operated on without a transanal drainage tube (group NTT). Clinicopathological and operative variables, the frequencies of anastomotic leakage and re-operation after leakage were investigated. Results: Between the two groups (Group TT and NTT), age, gender, body mass index, tumor size, Dukes’ stage, the number of Liniar stapler firings for rectal transaction, and the rate of left colic artery preservation were comparable. Intra-operative blood loss and operation time decreased group TT from group NTT (p < 0.05). The frequency of leakage was 2.8% (2/69) in group TT and was 13.2% (7/53) in group NTT. The rate of leakage was significantly lower in group TT (p = 0.03). Furthermore, the re-operation rate for symptomatic anastomotic leakage was 0% (0/2) in group TT, while in contrast it was 28.5% (2/7) in group NTT. The rate of re-operation was lower in group TT than group NTT (p = 0.07) and all cases with symptomatic leakage in group TT were cured by conservative treatment. There was no side effect of transanal drainage tube (perforation or bleeding of the colon, or deviation of the tube) in Group TT. Conclusions: Transanal drainage tube placement prevents anastomotic leakage after laparoscopic LAR. We regard the transnanal drainage tube to be safe and effective without side effect.