Significance of information obtained during transanal drainage tube placement after anterior resection of colorectal cancer

Abstract

Introduction: It has recently been reported that the placement of a transanal drainage tube after rectal cancer surgery reduces the rate of anastomotic leakage. However, transanal drainage tube cannot completely prevent anastomotic leakage and the management of transanal drainage tube needs to devise. We investigated the information obtained during transanal drainage tube placement and evaluated the relationship between these factors and anastomotic leakage.

Patients and methods: Fifty-one patients who underwent anterior resection of rectal cancer was retrospectively reviewed. transanal drainage tube was placed for more than 5 days after surgery. The daily fecal volume from transanal drainage tube was measured on postoperative day 1-5, and the defecation during transanal drainage tube placement was investigated.

Results: Anastomotic leakage during transanal drainage tube placement occurred in 4 patients. The anastomotic leakage rate during transanal drainage tube placement in patients whose maximum daily fecal volume or total fecal volume from the transanal drainage tube during postoperative days 1-5 was large was significantly higher than that in patients whose fecal volume was small. The anastomotic leakage rate of the patients with intentional defecation during transanal drainage tube placement was significantly higher than that of the patients without intentional defecation during transanal drainage tube placement. The maximum daily fecal volume and the total fecal volume from the transanal drainage tube during postoperative days 1-5 in patients who experienced intentional defecation during transanal drainage tube placement was significantly higher than that of patients without intentional defecation during transanal drainage tube placement.

Conclusion: A large fecal volume from transanal drainage tube after anterior rectal resection or intentional defecation in patients with transanal drainage tube placement were suggested to be risk factors for anastomotic leakage.

Fig 1. Association between anastomotic leakage during transanal drainage tube placement and the fecal volume from the transanal drainage tube.

(a) The anastomotic leakage during transanal drainage tube (TDT) placement-positive group had a significantly greater maximum daily fecal volume during POD 1–5 than the anastomotic leakage during TDT placement-negative group (median total fecal volume: 275.0 ml vs. 40.0 ml, respectively. p = 0.010). (b) The anastomotic leakage during TDT placement-positive group had a significantly greater total fecal volume during POD 1–5 than the anastomotic leakage during TDT placement-negative group (median total fecal volume: 522.0 ml vs. 80.0 ml, respectively. p = 0.010).

Fig 2. Association between intentional defecation and the fecal volume from the transanal drainage tube.

(a) The defecation-positive group have a significantly greater maximum daily fecal volume during postoperative days 1–5 in comparison to the defecation-negative group (Median total fecal volume: 100.0 ml vs. 35.0 ml, respectively. p = 0.026). (b) The defecation-positive group have a significantly greater total fecal volume during postoperative days 1–5 in comparison to the defecation-negative group (Median total fecal volume: 242.0 ml vs. 68.0 ml, respectively. p = 0.010).