Ann Surg Treat Res.  2021 Feb;100(2):100-108. 10.4174/astr.2021.100.2.100.

The usefulness of transanal tube for reducing anastomotic leak in mid rectal cancer: compared to diverting stoma

Affiliations
  • 1Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 2Department of Surgery, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea

Abstract

Purpose
Diverting stoma (DS) and transanal tube (TAT) are the 2 main procedures for reducing anastomotic leak (AL) in rectal cancer surgery. However, few studies have compared the protective effect of the 2 modalities against AL.
Methods
Total of 165 patients with mid rectal cancer, who underwent curative resection from 2012 to 2017, were included.Clinical characteristics and outcomes were compared. Risk factors for AL were identified using multivariate analysis.
Results
The DS group had lower tumor location, higher rates of neoadjuvant concurrent chemoradiotherapy, and longer operative time than the TAT group. However, the level of the anastomosis did not show statistically significant differences (DS: 4.6 cm vs. TAT: 4.9 cm, P = 0.061). AL occurred in 14 of the 165 patients (8.5%), with 10 (10.2%) in the DS group and 4 (6.0%) in the TAT group (P = 0.405). On multivariate analysis, only low body mass index (BMI) and smoking were significantly related to AL. Neither the protection method nor neoadjuvant chemoradiotherapy demonstrated statistical differences in AL. Seven of 10 patients in the DS group who experienced AL were treated conservatively, while all 4 in the TAT group underwent reoperation.
Conclusion
TAT seems to have comparable protective effect against AL to DS. However, in AL, DS appeared to be more effective in preventing reoperation. Therefore, DS is recommended in patients with low BMI or smoking, and with an expected higher probability of morbidity or mortality in case of reoperation. In other cases, TAT may be considered as an alternative to DS.

Keyword

Anastomotic leak; Rectal neoplasms; Surgical stomas
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