Fujino Shiki, Yasui Masayoshi, Ohue Masayuki, Miyoshi Norikatsu
Innovative Oncology Research and Regenerative Medicine, Osaka International Cancer Institute, Osaka 541-8567, Japan.
Department of Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan.
World J Gastrointest Surg. 2023 Jun 27;15(6):1202-1210. doi: 10.4240/wjgs.v15.i6.1202.
Anastomotic leakage (AL) following rectal cancer surgery is an important cause of mortality and recurrence. Although transanal drainage tubes (TDTs) are expected to reduce the rate of AL, their preventive effects are controversial.
To reveal the effect of TDT in patients with symptomatic AL after rectal cancer surgery.
A systematic literature search was performed using the PubMed, Embase, and Cochrane Library databases. We included randomized controlled trials (RCTs) and prospective cohort studies (PCSs) in which patients were assigned to two groups depending on the use or non-use of TDT and in which AL was evaluated. The results of the studies were synthesized using the Mantel-Haenszel random-effects model, and a two-tailed value > 0.05 was considered statistically significant.
Three RCTs and two PCSs were included in this study. Symptomatic AL was examined in all 1417 patients (712 with TDT), and TDTs did not reduce the symptomatic AL rate. In a subgroup analysis of 955 patients without a diverting stoma, TDT reduced the symptomatic AL rate (odds ratio = 0.50, 95% confidence interval: 0.29-0.86, = 0.012).
TDT may not reduce AL overall among patients undergoing rectal cancer surgery. However, patients without a diverting stoma may benefit from TDT placement.
直肠癌手术后吻合口漏（AL）是导致死亡和复发的重要原因。尽管经肛门引流管（TDT）有望降低AL发生率，但其预防效果仍存在争议。
揭示TDT对直肠癌手术后出现症状性AL患者的影响。
使用PubMed、Embase和Cochrane图书馆数据库进行系统文献检索。我们纳入了随机对照试验（RCT）和前瞻性队列研究（PCS），这些研究根据是否使用TDT将患者分为两组，并对AL进行了评估。研究结果采用Mantel-Haenszel随机效应模型进行综合分析，双侧P值>0.05被认为具有统计学意义。
本研究纳入了3项RCT和2项PCS。对所有1417例患者（712例使用TDT）进行了症状性AL检查，TDT并未降低症状性AL发生率。在对955例无转流造口患者的亚组分析中，TDT降低了症状性AL发生率（比值比=0.50，95%置信区间：0.29-0.86，P=0.012）。
TDT可能无法降低直肠癌手术患者总体的AL发生率。然而，无转流造口的患者可能从放置TDT中获益。
