Transanal Drainage Tubes do not prevent anastamotic leakage after Rectal Cancer surgery: JAMA

A group of researchers from China conducted a study to assess the effect of Transanal Drainage Tubes (TDTs) in AL prevention after laparoscopic low anterior resection for rectal cancer.

This multicenter randomized clinical trial with parallel groups (TDT vs non-TDT) was performed from February 26, 2016, to September 30, 2020. Participants included patients from 7 different hospitals in China who were undergoing laparoscopic low anterior resection with the double-stapling technique for mid-low rectal cancer; 576 patients were initially enrolled in this study, and 16 were later excluded. Ultimately, 560 patients were randomly divided between the Transanal Drainage Tube (TDT) and non-Transanal Drainage Tube (TDT) groups.

A silicone tube was inserted through the anus, and the tip of the tube was placed approximately 5 cm above the anastomosis under laparoscopy at the conclusion of surgery. The tube was fixed with a skin suture and connected to a drainage bag. The Transanal Drainage Tube (TDT) was scheduled for removal 3 to 7 days after surgery.

The primary end point was the postoperative AL rate within 30 days.

The results of the study are as follows:

· In total, 576 patients were initially enrolled in this study; 16 of these patients were excluded.

· Ultimately, 560 patients were randomly divided between the Transanal Drainage Tube (TDT) group; 177 men [63.2%]) and the non-Transanal Drainage Tube (TDT) group.

· Intention-to-treat analysis showed no significant difference between the Transanal Drainage Tube (TDT) and non-Transanal Drainage Tube (TDT) groups in AL rates or AL grades.

· In the stratified analysis based on diverting stomas, there was no significant difference in the AL rate between the groups, regardless of whether a diverting stoma was present.

· Anal pain was the most common complaint from patients in the Transanal Drainage Tube (TDT) group. Accidental early Transanal Drainage Tube (TDT) removal occurred in 20 patients (7.1%), and no bleeding or iatrogenic colonic perforations were detected.

Thus, the researchers concluded that the results from this randomized clinical trial indicated that Transanal Drainage Tubes (TDTs) may not confer any benefit for AL prevention in patients who undergo laparoscopic low anterior resection for mid-low rectal cancer without preoperative radiotherapy.

Reference:

Transanal Drainage Tube Use for Preventing Anastomotic Leakage After Laparoscopic Low Anterior Resection in Patients with Rectal Cancer: A Randomized Clinical Trial by Zhao S et. al published in the JAMA Surgery.

doi:10.1001/jamasurg.2021.4568