Yun Yang, MD, Shu Ye, MD, PhD. West China Hospital, Sichuan University
Objective: Anastomotic leakage is the most significant complication after low anterior resection (LAR) for rectal cancer, and it is the major cause of postoperative mortality and morbidity. The objective of the present study was to investigate whether the use of a new-type anatomical transanal decompression tube (ATDT) as an alternative endoluminal drainage technique for rectal cancer can reduce the leakage rate after LAR.
Methods: From September 2009 to June 2013, a total of 450 patients with or without anatomical transanal decompression technique were retrospectively analyzed. Inclusion criteria were biopsy-proven rectal cancer under 15 cm that is proximal from the dentate line; age: 18~80 years; informed consent; ability to understand the study information; anterior resection for the lesion; intact anastomotic stapler rings; and the absence of major intraoperative adverse events. Exclusive criteria included preoperative neoadjuvant therapy; intestinal obstruction and any other acute abdomen conditions; uncorrected anemia and hypoproteinemia in perioperative period.
Results: Patient demographics were compared between the groups of ATDT and Non-ATDT in general analysis. As a result, there were no significant differences in tumor size (p=0.254), location (0.912), anastomosis technique (0.632) and TNM stage (p=0.455) between the two groups. The overall rate of symptomatic leakage was 1.78% (8 of 450 patients). Patients with ATDT (n = 224) had leakage in 0.45% (1 of 224 patients) and those without ATDT (n = 226) in 3.10% (7 of 226 patients) (p = 0.033). All patients with anastomotic leakage received prophylactic transverse colon loop ostomy. The 30-day mortality after LAR was nil. A quicker resumption of gastrointestinal motility manifested by a smaller number of patients with flatus postoperative day (POD) greater than 3 (p=0.04). However, a shorter hospital stay was not observed in in the group of using anatomical transanal decompression tube (14.51±2.73 versus 14.58±3.74, P=0.819). With regard to the colorectal anastomosis (Circular Staple Technique) subgroup, 0.66% (1 of 151) patients with ATDT presented with a symptomatic anastomotic leakage, compared with 1.26% (2 of 159) of those without ATDT (p =0.592). Also there was no difference between ATDT (0%, 0/16) and Non-ATDT (5.56%, 1/18) in the ectropion pull-through technique subgroup (P=0.339). But in the coloanal anastomosis subgroup, there was a significant difference in that 0% (0 of 57) of those with ATDT presented with leakage, compared with 8.16% (4/49) of those without ATDT (p=0.028).
Conclusions: The new-type anatomical transanal decompression tube is effective and safe in decreasing the rate of clinically significant anastomotic leakage. The potential benefits of ATDT placement are of many aspects, including better drainage, reduction of endoluminal pressure, and promotion of gastrointestinal motility.