Division of Colon and Rectal Surgery, Department of Surgery, Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea.
Division of Colon and Rectal Surgery, Department of Surgery, Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea.
Asian J Surg. 2022 Dec;45(12):2639-2644. doi: 10.1016/j.asjsur.2021.12.026. Epub 2021 Dec 23.
Anastomotic leakage (AL) is one of the most serious complications of rectal cancer surgery. The aim of this study was to analyze the effectiveness and safety of transanal drainage tube (TDT) placement to prevent AL after low anterior resection (LAR) for rectal cancer.
In this retrospective study, the data of 556 patients with rectal cancer who underwent LAR using the double stapling technique between January 2001 and April 2016 were analyzed. The patients were divided two groups: the non-transanal drainage tube (NTDT) group comprised patients without a TDT (n = 341) and the transanal drainage tube (TDT) group, patients with a TDT (n = 215).
The overall rate of AL was 4.1% (n = 23). The AL rate was significantly lower in the TDT group. The AL rate was 5.6% (n = 19) in the NTDT group and 1.9% (n = 4) in the TDT group (p = 0.032). The mean time of AL postoperatively was 6.0 days. Among AL patients, the re-operation rate for AL was 84.2% (16/19) for the NTDT group and 75.0% (3/4) for the TDT group. Sex, age, BMI, neoadjuvant chemoradiation therapy, tumor location, and double stapler diameter were not analysized to be risk factors for AL after LAR. Non-use of a TDT (odds ratio, 0.106; 95% confidence interval, 0.013-0.843; p = 0.034) was established as a risk factor for AL in the logistic analysis.
Based on the present data, TDT placement can reduce the rate of AL following LAR using the double stapling technique for rectal cancer.
吻合口漏（AL）是直肠癌手术最严重的并发症之一。本研究旨在分析经肛门引流管（TDT）在预防直肠癌低位前切除术（LAR）后 AL 中的作用和安全性。
本回顾性研究分析了 2001 年 1 月至 2016 年 4 月期间采用双吻合器技术行 LAR 的 556 例直肠癌患者的数据。患者分为两组：非经肛门引流管（NTDT）组无 TDT（n=341）和经肛门引流管（TDT）组，有 TDT（n=215）。
总的 AL 发生率为 4.1%（n=23）。TDT 组的 AL 发生率明显较低。NTDT 组的 AL 发生率为 5.6%（n=19），TDT 组为 1.9%（n=4）（p=0.032）。AL 术后平均时间为 6.0 天。在 AL 患者中，NTDT 组 AL 再手术率为 84.2%（16/19），TDT 组为 75.0%（3/4）。性别、年龄、BMI、新辅助放化疗、肿瘤位置和双吻合器直径不是 LAR 后 AL 的危险因素。多因素分析显示，TDT 不使用（比值比，0.106；95%置信区间，0.013-0.843；p=0.034）是 AL 的危险因素。
根据目前的数据，TDT 放置可降低直肠癌双吻合器 LAR 后 AL 的发生率。
