Does a transanal drainage tube reduce anastomotic leakage? A matched cohort study in 144 patients undergoing laparoscopi
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ORIGINAL ARTICLE
Does a transanal drainage tube reduce anastomotic leakage? A matched cohort study in 144 patients undergoing laparoscopic sphincter‑saving surgery for rectal cancer A. Challine1 · A. Cazelles1 · A. Frontali1 · L. Maggiori1 · Y. Panis1 Received: 21 December 2019 / Accepted: 10 June 2020 © Springer Nature Switzerland AG 2020
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 sphinctersaving surgery for rectal cancer. Keywords Rectal cancer · Transanal drainage · Anastomotic leak
Introduction In rectal cancer patients, the goal of surgical management is to perform sphincter-saving surgery (SSS) with good oncologic outcomes, acceptable function, and no definitive stoma in the long term. However, we [1, 2] and others have demonstrated that occurrence of a clinical anastomotic leak (AL) not only increased significantly the risk of local recurrence but also impaired functional results and the chance to * Y. Panis [email protected] 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
avoid definitive stoma. For these reasons, several procedures have been proposed to reduce the AL rate observed after low SSS. One of these procedures is placement of a transanal drainage (TD) tube at the end of the operation. The aim of the TD is to reduce intraluminal pressure at the site of the anastomosis. Randomized s
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