Transanal Intubation for Preventing Colorectal Anastomotic Failure

Overview

Journal Int J Surg Oncol

Publisher Wiley

Specialties General Surgery
Oncology

Date 2024 Aug 19

PMID 39157264

Authors

Mykola Gordiichuk

Affiliations

Soon will be listed here.

Abstract

Introduction: Failure of low colorectal anastomosis remains challenging in surgical oncology, necessitating the exploration of new methods and improvements in existing preventive measures.

Materials And Methods: This prospective study was conducted in two stages: intraluminal pressure in the colon was monitored in 32 patients by manometry and sonography over a 5-day postoperative period; 213 patients who underwent anterior resection of the rectum were analyzed, of whom 126 and 87 underwent diverting stoma (DS) and transanal intubation (TAI), respectively.

Results: The effectiveness of the recommended technique for applying and removing transanal intubation (TAI) to prevent pneumo hydro strike (≥15 kPa) on the anastomosis line was analyzed in 87 patients and compared with imposed DS. TAI showed better borderline statistical significance ( = 0.051). The incidence of repeat surgery for anastomotic failure (AL) was seven (5.55%) and four (4.59%) in the DS and TAI groups, respectively. The distance of the anastomosis from the dentate line <60 mm was associated with a higher risk of AL occurrence (odds ratio (OR), 1.012; 95% confidence interval (CI), 1.007-1.017; < 0.001; area under the curve (AUC) = 0.82). DS is recommended for men, as the risk of AL is significantly lower among women (OR, 0.41; 95% CI, 0.16-1.04; = 0.062; AUC, 0.61; 95% CI, 0.54-0.67).

Conclusions: Although TAI is advantageous over DS for preventing AL, surgeons select the method for the preventive approach based on the preoperative and intraoperative results.

References

Nishigori H, Ito M, Nishizawa Y, Nishizawa Y, Kobayashi A, Sugito M . 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. View

Verlaan T, Bartels S, van Berge Henegouwen M, Tanis P, Fockens P, Bemelman W . Early, minimally invasive closure of anastomotic leaks: a new concept. Colorectal Dis. 2011; 13 Suppl 7:18-22. DOI: 10.1111/j.1463-1318.2011.02775.x. View

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

Wong N, Eu K . A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective, comparative study. Dis Colon Rectum. 2005; 48(11):2076-9. DOI: 10.1007/s10350-005-0146-1. View

Nesbakken A, Nygaard K, Lunde O . Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg. 2001; 88(3):400-4. DOI: 10.1046/j.1365-2168.2001.01719.x. View

Wang F, Yan W, Yan M, Song M . Comparison of anastomotic leakage rate and reoperation rate between transanal tube placement and defunctioning stoma after anterior resection: A network meta-analysis of clinical data. Eur J Surg Oncol. 2019; 45(8):1301-1309. DOI: 10.1016/j.ejso.2019.01.182. View

Bray F, Ferlay J, Soerjomataram I, Siegel R, Torre L, Jemal A . Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6):394-424. DOI: 10.3322/caac.21492. View

Peeters K, Tollenaar R, Marijnen C, Kranenbarg E, Steup W, Wiggers T . Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg. 2004; 92(2):211-6. DOI: 10.1002/bjs.4806. View

Rahbari N, Weitz J, Hohenberger W, Heald R, Moran B, Ulrich A . Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2009; 147(3):339-51. DOI: 10.1016/j.surg.2009.10.012. View

10.

Boccola M, Buettner P, Rozen W, Siu S, Stevenson A, Stitz R . Risk factors and outcomes for anastomotic leakage in colorectal surgery: a single-institution analysis of 1576 patients. World J Surg. 2010; 35(1):186-95. DOI: 10.1007/s00268-010-0831-7. View

11.

Zhao W, Li N, He D, Feng J . Transanal Tube for the Prevention of Anastomotic Leakage After Rectal Cancer Surgery: A Systematic Review and Meta-analysis. World J Surg. 2016; 41(1):267-276. DOI: 10.1007/s00268-016-3758-9. View

12.

Tan W, Tang C, Shi L, Eu K . 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. View

13.

Ito T, Obama K, Sato T, Matsuo K, Inoue H, Kubota K . Usefulness of transanal tube placement for prevention of anastomotic leakage following laparoscopic low anterior resection. Asian J Endosc Surg. 2016; 10(1):17-22. DOI: 10.1111/ases.12310. View

14.

Jestin P, Pahlman L, Gunnarsson U . Risk factors for anastomotic leakage after rectal cancer surgery: a case-control study. Colorectal Dis. 2008; 10(7):715-21. DOI: 10.1111/j.1463-1318.2007.01466.x. View

15.

Chen Y, Bo X, Gu D, Gao W, Sheng W, Zhang B . Outcomes of laparoscopic abdominoperineal resection in low rectal cancer using different pelvic drainages. Asian Pac J Cancer Prev. 2015; 16(1):153-5. DOI: 10.7314/apjcp.2015.16.1.153. View

16.

Goto S, Hida K, Kawada K, Okamura R, Hasegawa S, Kyogoku T . Multicenter analysis of transanal tube placement for prevention of anastomotic leak after low anterior resection. J Surg Oncol. 2017; 116(8):989-995. DOI: 10.1002/jso.24760. View

17.

Zhao W, Hu F, Li Y, Li H, Luo W, Sun F . Use of a transanal drainage tube for prevention of anastomotic leakage and bleeding after anterior resection for rectal cancer. World J Surg. 2012; 37(1):227-32. DOI: 10.1007/s00268-012-1812-9. View

18.

Floodeen H, Hallbook O, Hagberg L, Matthiessen P . Costs and resource use following defunctioning stoma in low anterior resection for cancer - A long-term analysis of a randomized multicenter trial. Eur J Surg Oncol. 2017; 43(2):330-336. DOI: 10.1016/j.ejso.2016.12.003. View

19.

Kang C, Halabi W, Chaudhry O, Nguyen V, Pigazzi A, Carmichael J . Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg. 2012; 148(1):65-71. DOI: 10.1001/2013.jamasurg.2. View

20.

Strangio G, Zullo A, Ferrara E, Anderloni A, Carlino A, Jovani M . Endo-sponge therapy for management of anastomotic leakages after colorectal surgery: A case series and review of literature. Dig Liver Dis. 2015; 47(6):465-9. DOI: 10.1016/j.dld.2015.02.007. View