Top

World Journal of Surgical Oncology

Published in:

Open Access 01-12-2016 | Research

Efficacy of transanal tube placement after anterior resection for rectal cancer: a systematic review and meta-analysis

Authors: Shuanhu Wang, Zongbing Zhang, Mulin Liu, Shiqing Li, Congqiao Jiang

Published in: World Journal of Surgical Oncology | Issue 1/2016

Abstract

Background

Anastomotic leakage is a serious complication that can occur after anterior resection of the rectum. There is a question regarding whether the placement of a transanal tube can decrease the rate of anastomotic leakage. The aim of this systematic review and meta-analysis was to evaluate the efficacy of transanal tube placement after anterior resection.

Methods

We searched three major databases (PubMed, Embase, and the Cochrane Library) up until January 2015 for studies evaluating the benefit of transanal tubes after anterior resection for rectal cancer. The primary outcome measure was the rate of clinical anastomotic leakage. Secondary outcome was the rate of reoperation. Pooled risk ratios (RR) with 95 % confidence intervals (CI) were obtained using random effects models.

Results

One randomized controlled trial and three observational studies involving 909 patients met inclusion criteria. Clinical anastomotic leakage occurred in 3.49 % (14 of 401) of patients with transanal tubes and 12.01 % (61 of 508) of patients without transanal tubes. Meta-analysis of the studies showed a lower risk of anastomotic leakage (RR, 0.32; 95 % CI 0.18–0.58) and reoperation related to leakage (RR, 0.19; 95 % CI 0.08–0.46) when the transanal tube was placed.

Conclusions

While studies are few and mostly observational, the data to date indicate that placement of a transanal tube decreases the rate of clinical anastomotic leakage and reoperation related to leakage. More studies are needed to confirm these findings.

Dixon CF. Anterior resection for malignant lesions of the upper part of the rectum and lower part of the sigmoid. Ann Surg. 1948;128(3):425–42.CrossRefPubMedPubMedCentral

Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147(3):339–51. doi:10.1016/j.surg.2009.10.012.CrossRefPubMed

Cong ZJ, Hu LH, Bian ZQ, Ye GY, Yu MH, Gao YH, et al. Systematic review of anastomotic leakage rate according to an international grading system following anterior resection for rectal cancer. PLoS One. 2013;8(9), e75519. doi:10.1371/journal.pone.0075519.CrossRefPubMedPubMedCentral

Kulu Y, Tarantio I, Warschkow R, Kny S, Schneider M, Schmied BM, et al. Anastomotic leakage is associated with impaired overall and disease-free survival after curative rectal cancer resection: a propensity score analysis. Ann Surg Oncol. 2015;22(6):2059–67. doi:10.1245/s10434-014-4187-3.CrossRefPubMed

Law WL, Choi HK, Lee YM, Ho JW, Seto CL. Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg. 2007;11(1):8–15. doi:10.1007/s11605-006-0049-z.CrossRefPubMed

Kang CY, Halabi WJ, Chaudhry OO, Nguyen V, Pigazzi A, Carmichael JC, et al. Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg. 2013;148(1):65–71. doi:10.1001/2013.jamasurg.2.CrossRefPubMed

Matthiessen P, Hallbook O, Andersson M, Rutegard J, Sjodahl R. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis. 2004;6(6):462–9. doi:10.1111/j.1463-1318.2004.00657.x.CrossRefPubMed

Chen J, Wang DR, Yu HF, Zhao ZK, Wang LH, Li YK. Defunctioning stoma in low anterior resection for rectal cancer: a meta-analysis of five recent studies. Hepatogastroenterology. 2012;59(118):1828–31. doi:10.5754/hge11786.PubMed

Gu WL, Wu SW. Meta-analysis of defunctioning stoma in low anterior resection with total mesorectal excision for rectal cancer: evidence based on thirteen studies. World J Surg Oncol. 2015;13:9. doi:10.1186/s12957-014-0417-1.CrossRefPubMedPubMedCentral

10.

Huser N, Michalski CW, Erkan M, Schuster T, Rosenberg R, Kleeff J, et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg. 2008;248(1):52–60. doi:10.1097/SLA.0b013e318176bf65.CrossRefPubMed

11.

Tan WS, Tang CL, Shi L, Eu KW. Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg. 2009;96(5):462–72. doi:10.1002/bjs.6594.CrossRefPubMed

12.

Thoker M, Wani I, Parray FQ, Khan N, Mir SA, Thoker P. Role of diversion ileostomy in low rectal cancer: a randomized controlled trial. Int J Surg. 2014;12(9):945–51. doi:10.1016/j.ijsu.2014.07.012.CrossRefPubMed

13.

Patrascu T, Doran H, Musat O. Protective transanal tube in colo-rectal anastomosis. Chirurgia (Bucur). 2004;99(1):75–8.

14.

Cong ZJ, Fu CG, Wang HT, Liu LJ, Zhang W, Wang H. Influencing factors of symptomatic anastomotic leakage after anterior resection of the rectum for cancer. World J Surg. 2009;33(6):1292–7. doi:10.1007/s00268-009-0008-4.CrossRefPubMed

15.

Eckmann C, Kujath P, Schiedeck TH, Shekarriz H, Bruch HP. Anastomotic leakage following low anterior resection: results of a standardized diagnostic and therapeutic approach. Int J Colorectal Dis. 2004;19(2):128–33. doi:10.1007/s00384-003-0498-8.CrossRefPubMed

16.

Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007;246(2):207–14. doi:10.1097/SLA.0b013e3180603024.CrossRefPubMedPubMedCentral

17.

Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12.CrossRefPubMed

18.

Lo CK, Mertz D, Loeb M. Newcastle-Ottawa Scale: comparing reviewers’ to authors’ assessments. BMC Med Res Methodol. 2014;14:45. doi:10.1186/1471-2288-14-45.CrossRefPubMedPubMedCentral

19.

Xiao L, Zhang WB, Jiang PC, Bu XF, Yan Q, Li H, et al. Can transanal tube placement after anterior resection for rectal carcinoma reduce anastomotic leakage rate? A single-institution prospective randomized study. World J Surg. 2011;35(6):1367–77. doi:10.1007/s00268-011-1053-3.CrossRefPubMed

20.

Nishigori H, Ito M, Nishizawa Y, Nishizawa Y, Kobayashi A, Sugito M, et al. Effectiveness of a transanal tube for the prevention of anastomotic leakage after rectal cancer surgery. World J Surg. 2014;38(7):1843–51. doi:10.1007/s00268-013-2428-4.CrossRefPubMed

21.

Hidaka E, Ishida F, Mukai S, Nakahara K, Takayanagi D, Maeda C, et al. 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. 2015;29(4):863–7. doi:10.1007/s00464-014-3740-2.CrossRefPubMed

22.

Zhao WT, Hu FL, Li YY, Li HJ, Luo WM, Sun F. Use of a transanal drainage tube for prevention of anastomotic leakage and bleeding after anterior resection for rectal cancer. World J Surg. 2013;37(1):227–32. doi:10.1007/s00268-012-1812-9.CrossRefPubMed

23.

Bordeianou L, Maguire LH, Alavi K, Sudan R, Wise PE, Kaiser AM. Sphincter-sparing surgery in patients with low-lying rectal cancer: techniques, oncologic outcomes, and functional results. J Gastrointest Surg. 2014;18(7):1358–72. doi:10.1007/s11605-014-2528-y.CrossRefPubMedPubMedCentral

24.

Moran BJ. Predicting the risk and diminishing the consequences of anastomotic leakage after anterior resection for rectal cancer. Acta Chir Iugosl. 2010;57(3):47–50.CrossRefPubMed

25.

Yang L, Huang XE, Zhou JN. Risk assessment on anastomotic leakage after rectal cancer surgery: an analysis of 753 patients. Asian Pac J Cancer Prev. 2013;14(7):4447–53.CrossRefPubMed

26.

Guenaga KF, Lustosa SA, Saad SS, Saconato H, Matos D. Ileostomy or colostomy for temporary decompression of colorectal anastomosis. Cochrane Database Syst Rev. 2007;1, CD004647. doi:10.1002/14651858.CD004647.pub2.PubMed

27.

Montemurro S, De Luca R, Caliandro C, Ruggieri E, Rucci A, Sciscio V, et al. Transanal tube NO COIL(R) after rectal cancer proctectomy. The “G. Paolo II” Cancer Centre experience. Tumori. 2012;98(5):607–14. doi:10.1700/1190.13202.PubMed

28.

Montemurro S, Caliandro C, Ruggeri E, Rucci A, Sciscio V. Endoluminal pressure: risk factor for anastomotic dehiscence in rectal carcinoma. Preliminary results. Chir Ital. 2001;53(4):529–36.PubMed

29.

Shigeta K, Baba H, Yamafuji K, Kubochi K. A meta-analysis of use of transanal tube to prevent anastomotic leakage after anterior resection for rectal cancer. Colorectal Disease. 2014;16:87.

30.

Zhao JK, Chen NZ, Zheng JB, He S, Sun XJ. Laparoscopic versus open surgery for rectal cancer: results of a systematic review and meta-analysis on clinical efficacy. Mol Clin Oncol. 2014;2(6):1097–102. doi:10.3892/mco.2014.345.PubMedPubMedCentral

31.

Rickert A, Herrle F, Doyon F, Post S, Kienle P. Influence of conversion on the perioperative and oncologic outcomes of laparoscopic resection for rectal cancer compared with primarily open resection. Surg Endosc. 2013;27(12):4675–83. doi:10.1007/s00464-013-3108-z.CrossRefPubMed

Title: Efficacy of transanal tube placement after anterior resection for rectal cancer: a systematic review and meta-analysis
Authors: Shuanhu Wang
Zongbing Zhang
Mulin Liu
Shiqing Li
Congqiao Jiang
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: World Journal of Surgical Oncology / Issue 1/2016
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/s12957-016-0854-0

At a glance: The STEP trials

Springer Medicine

Efficacy of transanal tube placement after anterior resection for rectal cancer: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2016

A cost-effective handheld breast scanner for use in low-resource environments: a validation study

Cytokeratin 7-positive/cytokeratin 20-negative cecal adenocarcinoma metastatic to the uterine cervix: a case report

The potential of deferasirox as a novel therapeutic modality in gastric cancer

Totally laparoscopic gastrectomy using intracorporeally stapler or hand-sewn anastomosis for gastric cancer: a single-center experience of 478 consecutive cases and outcomes

Deciphering the anti-angiogenic effect of endostatin/cyclophosphamide to normalize tumor micrangium through notch signaling pathway in colon cancer

Invasive micropapillary carcinoma of the breast had poor clinical characteristics but showed no difference in prognosis compared with invasive ductal carcinoma