Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2023; 15(6): 1202-1210
Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1202
Efficacy of transanal drainage tube in preventing anastomotic leakage after surgery for rectal cancer: A meta-analysis
Shiki Fujino, Masayoshi Yasui, Masayuki Ohue, Norikatsu Miyoshi
Shiki Fujino, Norikatsu Miyoshi, Innovative Oncology Research and Regenerative Medicine, Osaka International Cancer Institute, Osaka 541-8567, Japan
Masayoshi Yasui, Masayuki Ohue, Department of Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
Author contributions: Fujino S, Yasui M, Ohue M, and Miyoshi N designed the research study; Fujino S, Yasui M, and Miyoshi N performed the research; Fujino S and Miyoshi N analyzed the data; Fujino S wrote the manuscript; and all authors have read and approve the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Norikatsu Miyoshi, FACS, FASCRS, FICS, MD, PhD, Assistant Professor, Innovative Oncology Research and Regenerative Medicine, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka 541-8567, Japan. nmiyoshi@gesurg.med.osaka-u.ac.jp
Received: December 26, 2022
Peer-review started: December 26, 2022
First decision: February 21, 2023
Revised: March 21, 2023
Accepted: April 25, 2023
Article in press: April 25, 2023
Published online: June 27, 2023
Processing time: 171 Days and 10.8 Hours
Abstract
BACKGROUND

Anastomotic leakage (AL) following rectal cancer surgery is an important cause of mortality and recurrence. Although transanal drainage tubes (TDTs) are expected to reduce the rate of AL, their preventive effects are controversial.

AIM

To reveal the effect of TDT in patients with symptomatic AL after rectal cancer surgery.

METHODS

A systematic literature search was performed using the PubMed, Embase, and Cochrane Library databases. We included randomized controlled trials (RCTs) and prospective cohort studies (PCSs) in which patients were assigned to two groups depending on the use or non-use of TDT and in which AL was evaluated. The results of the studies were synthesized using the Mantel-Haenszel random-effects model, and a two-tailed P value > 0.05 was considered statistically significant.

RESULTS

Three RCTs and two PCSs were included in this study. Symptomatic AL was examined in all 1417 patients (712 with TDT), and TDTs did not reduce the symptomatic AL rate. In a subgroup analysis of 955 patients without a diverting stoma, TDT reduced the symptomatic AL rate (odds ratio = 0.50, 95% confidence interval: 0.29–0.86, P = 0.012).

CONCLUSION

TDT may not reduce AL overall among patients undergoing rectal cancer surgery. However, patients without a diverting stoma may benefit from TDT placement.

Keywords: Meta-analysis; Drainage; Transanal; Anastomotic leakage; Surgical stomas; Rectal cancer

Core Tip: Anastomotic leakage (AL) following rectal cancer surgery is a serious problem, and a transanal drainage tube (TDT) is expected to reduce AL. However, the preventive effects of TDT placement are controversial. Thus, we performed a meta-analysis of three randomized controlled trials and two prospective cohort studies. A systematic literature search was performed, and the results of the meta-analysis were synthesized using the Mantel-Haenszel random-effects model. Overall, TDT did not significantly reduce the symptomatic AL rate, but it did among patients without a diverting stoma.