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01-02-2016

A meta-analysis of the use of a transanal drainage tube to prevent anastomotic leakage after anterior resection by double-stapling technique for rectal cancer

Authors: Kohei Shigeta, Koji Okabayashi, Hideo Baba, Hirotoshi Hasegawa, Masashi Tsuruta, Kazuo Yamafuji, Kiyoshi Kubochi, Yuko Kitagawa

Published in: Surgical Endoscopy | Issue 2/2016

Abstract

Background

The safety and efficacy of transanal drainage tube (TDT) placement to decrease the risk of postoperative anastomotic leakage after rectal cancer surgery has not been validated. The objective of this meta-analysis was to evaluate the usefulness of a TDT for the prevention of anastomotic leakage after an anterior resection for rectal cancer.

Methods

The PubMed and Cochrane Library databases were searched for studies comparing TDT and non-TDT. The endpoint utilized in this study was defined as the rates of anastomotic leakage and re-operation. The relative effects of these variables were synthesized using Review Manager 5.1 software.

Results

Four trials including 909 participants (401 TDT cases and 508 non-TDT cases) met our inclusion criteria. The weighted mean anastomotic leakage rate was 4 % [95 % confidence interval (CI) 1–6 %], and a significantly lower risk of anastomotic leakage was identified in the TDT group compared with the non-TDT group [odds ratio (OR) 0.30; 95 % CI 0.16–0.55; p = 0.0001]. Furthermore, there were significant differences between the TDT and non-TDT groups in terms of the re-operation rate (OR 0.18; 95 % CI 0.07–0.44; p = 0.0002). No significant covariates related to anastomotic leakage or re-operation were identified in meta-regression analysis. Both the anastomotic leakage and re-operation rates for all studies lay inside the 95 % confidence interval boundaries. No visible publication bias was found by visual assessment of the funnel plot (Egger’s test; anastomotic leakage: p = 0.056, re-operation: p = 0.681).

Conclusions

Placement of a TDT is an effective and safe procedure that can decrease the rate of anastomotic leakage and re-operation after an anterior resection.

Kuroyanagi H, Akiyoshi T, Oya M, Fujimoto Y, Ueno M, Yamaguchi T, Muto T (2009) Laparoscopic-assisted anterior resection with double-stapling technique anastomosis: safe and feasible for lower rectal cancer? Surg Endosc 23:2197–2202CrossRefPubMed

Milsom JW, de Oliveira O Jr, Trencheva KI, Pandey S, Lee SW, Sonoda T (2009) Long-term outcomes of patients undergoing curative laparoscopic surgery for mid and low rectal cancer. Dis Colon Rectum 52:1215–1222CrossRefPubMed

Okuda J, Tanaka K, Kondo K, Asai K, Kayano H, Yamamoto M, Tanigawa N (2011) Safe anastomosis in laparoscopic low anterior resection for rectal cancer. Asian J Endosc Surg 4:68–72CrossRefPubMed

Nesbakken A, Nygaard K, Lunde OC (2001) Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg 88:400–404CrossRefPubMed

Branagan G, Finnis D, Wessex Colorectal Cancer Audit Working G (2005) Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum 48:1021–1026CrossRefPubMed

Law WL, Choi HK, Lee YM, Ho JW, Seto CL (2007) Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg 11:8–15CrossRefPubMed

Bell SW, Walker KG, Rickard MJ, Sinclair G, Dent OF, Chapuis PH, Bokey EL (2003) Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg 90:1261–1266CrossRefPubMed

Ptok H, Marusch F, Meyer F, Schubert D, Gastinger I, Lippert H, Study Group Colon/Rectum C (2007) Impact of anastomotic leakage on oncological outcome after rectal cancer resection. Br J Surg 94:1548–1554CrossRefPubMed

Lee WS, Yun SH, Roh YN, Yun HR, Lee WY, Cho YB, Chun HK (2008) Risk factors and clinical outcome for anastomotic leakage after total mesorectal excision for rectal cancer. World J Surg 32:1124–1129CrossRefPubMed

10.

Bertelsen CA, Andreasen AH, Jorgensen T, Harling H, Danish Colorectal Cancer G (2010) Anastomotic leakage after anterior resection for rectal cancer: risk factors. Colorectal Dis 12:37–43CrossRefPubMed

11.

Konishi T, Watanabe T, Kishimoto J, Nagawa H (2006) Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance. J Am Coll Surg 202:439–444CrossRefPubMed

12.

Warschkow R, Steffen T, Thierbach J, Bruckner T, Lange J, Tarantino I (2011) Risk factors for anastomotic leakage after rectal cancer resection and reconstruction with colorectostomy. A retrospective study with bootstrap analysis. Ann Surg Oncol 18:2772–2782CrossRefPubMed

13.

Park JS, Choi GS, Kim SH, Kim HR, Kim NK, Lee KY, Kang SB, Kim JY, Lee KY, Kim BC, Bae BN, Son GM, Lee SI, Kang H (2013) Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg 257:665–671CrossRefPubMed

14.

Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl R (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246:207–214PubMedCentralCrossRefPubMed

15.

Shiomi A, Ito M, Saito N, Ohue M, Hirai T, Kubo Y, Moriya Y (2011) Diverting stoma in rectal cancer surgery. A retrospective study of 329 patients from Japanese cancer centers. Int J Colorectal Dis 26:79–87CrossRefPubMed

16.

Chude GG, Rayate NV, Patris V, Koshariya M, Jagad R, Kawamoto J, Lygidakis NJ (2008) Defunctioning loop ileostomy with low anterior resection for distal rectal cancer: should we make an ileostomy as a routine procedure? A prospective randomized study. Hepatogastroenterology 55:1562–1567PubMed

17.

Nugent KP, Daniels P, Stewart B, Patankar R, Johnson CD (1999) Quality of life in stoma patients. Dis Colon Rectum 42:1569–1574CrossRefPubMed

18.

Singh H, Latosinsky S, Spiegel BM, Targownik LE (2006) The cost-effectiveness of colonic stenting as a bridge to curative surgery in patients with acute left-sided malignant colonic obstruction: a Canadian perspective. Can J Gastroenterol 20:779–785PubMedCentralPubMed

19.

Phatak UR, Kao LS, You YN, Rodriguez-Bigas MA, Skibber JM, Feig BW, Nguyen S, Cantor SB, Chang GJ (2014) Impact of ileostomy-related complications on the multidisciplinary treatment of rectal cancer. Ann Surg Oncol 21:507–512PubMedCentralCrossRefPubMed

20.

Hidaka E, Ishida F, Mukai S, Nakahara K, Takayanagi D, Maeda C, Takehara Y, Tanaka JI, Kudo SE (2014) Efficacy of transanal tube for prevention of anastomotic leakage following laparoscopic low anterior resection for rectal cancers: a retrospective cohort study in a single institution. Surg Endosc 29:863–867CrossRefPubMed

21.

Nishigori H, Ito M, Nishizawa Y, Nishizawa Y, Kobayashi A, Sugito M, Saito N (2014) Effectiveness of a transanal tube for the prevention of anastomotic leakage after rectal cancer surgery. World J Surg 38:1843–1851CrossRefPubMed

22.

Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097CrossRef

23.

Stang A (2010) Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605CrossRefPubMed

24.

Xiao L, Zhang WB, Jiang PC, Bu XF, Yan Q, Li H, Zhang YJ, Yu F (2011) Can transanal tube placement after anterior resection for rectal carcinoma reduce anastomotic leakage rate? A single-institution prospective randomized study. World J Surg 35:1367–1377CrossRefPubMed

25.

Zhao WT, Hu FL, Li YY, Li HJ, Luo WM, Sun F (2013) Use of a transanal drainage tube for prevention of anastomotic leakage and bleeding after anterior resection for rectal cancer. World J Surg 37:227–232CrossRefPubMed

26.

Cong ZJ, Fu CG, Wang HT, Liu LJ, Zhang W, Wang H (2009) Influencing factors of symptomatic anastomotic leakage after anterior resection of the rectum for cancer. World J Surg 33:1292–1297CrossRefPubMed

27.

Frasson M, Flor-Lorente B, Rodriguez JL, Granero-Castro P, Hervas D, Alvarez Rico MA, Brao MJ, Sanchez Gonzalez JM, Garcia-Granero E, Group AS (2014) Risk factors for anastomotic leak after colon resection for cancer: multivariate analysis and nomogram from a multicentric, prospective, national study with 3193 patients. Ann Surg. doi:10.1097/SLA.0000000000000973

28.

Hinoi T, Okajima M, Shimomura M, Egi H, Ohdan H, Konishi F, Sugihara K, Watanabe M (2013) Effect of left colonic artery preservation on anastomotic leakage in laparoscopic anterior resection for middle and low rectal cancer. World J Surg 37:2935–2943CrossRefPubMed

29.

Montemurro S, Caliandro C, Ruggeri E, Rucci A, Sciscio V (2001) Endoluminal pressure: risk factor for anastomotic dehiscence in rectal carcinoma. Preliminary results. Chir Ital 53:529–536PubMed

30.

Sterk P, Schubert F, Gunter S, Klein P (2001) Anastomotic protection with a transanal tube after rectum resection and total mesorectal excision. Zentralblatt fur Chirurgie 126:601–604CrossRefPubMed

31.

Guenaga KF, Lustosa SA, Saad SS, Saconato H, Matos D (2008) Ileostomy or colostomy for temporary decompression of colorectal anastomosis. Systematic review and meta-analysis. Acta cirurgica brasileira/Sociedade Brasileira para Desenvolvimento Pesquisa em Cirurgia 23:294–303PubMed

32.

Poon RT, Chu KW, Ho JW, Chan CW, Law WL, Wong J (1999) Prospective evaluation of selective defunctioning stoma for low anterior resection with total mesorectal excision. World J Surg 23:463–467 (discussion 467-468) CrossRefPubMed

33.

Alberts JC, Parvaiz A, Moran BJ (2003) Predicting risk and diminishing the consequences of anastomotic dehiscence following rectal resection. Colorectal Dis 5:478–482CrossRefPubMed

34.

Peeters KC, Tollenaar RA, Marijnen CA, Klein Kranenbarg E, Steup WH, Wiggers T, Rutten HJ, van de Velde CJ, Dutch Colorectal Cancer G (2005) Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 92:211–216CrossRefPubMed

35.

Fischer A, Schrag HJ, Goos M, Obermaier R, Hopt UT, Baier PK (2008) Transanal endoscopic tube decompression of acute colonic obstruction: experience with 51 cases. Surg Endosc 22:683–688CrossRefPubMed

36.

Shigeta K, Baba H, Yamafuji K, Kaneda H, Katsura H, Kubochi K (2014) Outcomes for patients with obstructing colorectal cancers treated with one-stage surgery using transanal drainage tubes. J Gastrointest Surg 18:1507–1513CrossRefPubMed

37.

Shada AL, Rosenberger LH, Mentrikoski MJ, Silva MA, Feldman SH, Kleiner DE (2014) Endoluminal negative-pressure therapy for preventing rectal anastomotic leaks: a pilot study in a pig model. Surg Infect 15:123–130CrossRef

38.

Sirois-Giguere E, Boulanger-Gobeil C, Bouchard A, Gagne JP, Gregoire RC, Thibault C, Bouchard P (2013) Transanal drainage to treat anastomotic leaks after low anterior resection for rectal cancer: a valuable option. Dis Colon Rectum 56:586–592CrossRefPubMed

39.

Okoshi K, Masano Y, Hasegawa S, Hida K, Kawada K, Nomura A, Kawamura J, Nagayama S, Yoshimura T, Sakai Y (2013) Efficacy of transanal drainage for anastomotic leakage after laparoscopic low anterior resection of the rectum. Asian J Endosc Surg 6:90–95CrossRefPubMed

40.

Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, Daban A, Bardet E, Beny A, Ollier JC, Trial ERG (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123CrossRefPubMed

41.

Roh MS, Colangelo LH, O’Connell MJ, Yothers G, Deutsch M, Allegra CJ, Kahlenberg MS, Baez-Diaz L, Ursiny CS, Petrelli NJ, Wolmark N (2009) Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol 27:5124–5130PubMedCentralCrossRefPubMed

42.

Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69:613–616CrossRefPubMed

Title: A meta-analysis of the use of a transanal drainage tube to prevent anastomotic leakage after anterior resection by double-stapling technique for rectal cancer
Authors: Kohei Shigeta
Koji Okabayashi
Hideo Baba
Hirotoshi Hasegawa
Masashi Tsuruta
Kazuo Yamafuji
Kiyoshi Kubochi
Yuko Kitagawa
Publication date: 01-02-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 2/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4237-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A meta-analysis of the use of a transanal drainage tube to prevent anastomotic leakage after anterior resection by double-stapling technique for rectal cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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