Does rectal tube/transanal stent placement after an anterior resection for rectal cancer reduce anastomotic leak? A systematic review and meta-analysis

Choy, KT; Yang, TWW; Heriot, A; Warrier, SK; Kong, JC

Author(s): Choy, KT; Yang, TWW; Heriot, A; Warrier, SK; Kong, JC;
Details: Publication Year 2021-06,Volume 36,Issue #6,Page 1123-1132
Journal Title: International Journal of Colorectal Disease
Publication Type: Review
Abstract: BACKGROUND: There is increasing evidence that either a transanal stent (TAS) or rectal tube (RT) can decrease the risk of anastomotic leakage (AL) after anterior resection for rectal cancer, in which a diverting stoma may not be required. OBJECTIVES: The aim of this review was to investigate the efficacy and safety of RT/TAS in preventing AL after anterior resections. DATA SOURCES: An up-to-date systematic review was performed on the available literature between 2000 and 2020 on PubMed, EMBASE, Medline and Cochrane Library databases. STUDY SELECTION: All studies reporting on anterior resections in adults, comparing transanal tube/stent versus non-tube/stent, were analysed. MAIN OUTCOME MEASURE: The primary outcome was rates of AL, whereas secondary outcomes compared associated unplanned re-operation for AL and hospital length of stay (LOS). RESULTS: Two randomized controlled trials and 13 observational studies were included, with 1714 patients receiving RT/TAS and 1741 patients without. There were 119 (7%) patients with AL in the RT/TAS group compared to 216 (12.3%) patients in the non-RT/TAS group (OR: 0.48, 95% CI: 0.38-0.62, p < 0.001). There were 47 (2.9%) patients with AL complications requiring surgery in the RT/TAS group compared to 132 (8%) patients in the non-RT/TAS group (OR: 0.29, 95% CI: 0.20-0.42, p < 0.001) and no significant difference identified with the standardized mean difference (SMD) favouring the RT/TAS group for hospital LOS (SMD: -0.23, 95% CI: -0.51 to 0.06, p = 0.115). CONCLUSION: The use of RT/TAS post restorative anterior resection for rectal cancer should be considered, given the benefits shown from this meta-analysis.
Keywords: Adult; Anastomosis, Surgical/adverse effects; Anastomotic Leak/etiology/prevention & control; *Digestive System Surgical Procedures; Humans; *Rectal Neoplasms/surgery; Stents/adverse effects
Department(s): Surgical Oncology
PubMed ID: 33515307
Publisher's Version: https://doi.org/10.1007/s00384-021-03851-8
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2025-06-20 08:03:22

Last Modified: 2025-06-20 08:04:25