Transanal drainage tube placement in patients with temporary ileostomy after laparoscopic rectal resection for rectal...

Anastomotic leakage is a serious complication after surgery for rectal cancer. The prevention of anastomotic leakage is important, and prevention methods include temporary ileostomy and transanal drainage tubes. In clinical practice, a TDT is often used in combination with a temporary ileostomy. Many studies have compared ileostomy and TDT; however, there are few reports on the additive effects of TDT in patients with temporary ileostomy. We included patients who underwent laparoscopic surgery for rectal cancer (cT1-2/N0/M0) located within 5 cm of the anal verge at 47 specialized centers in Japan between 2014 and 2017. Gastrointestinal anastomosis was performed in the patients, and a temporary ileostomy was created. Eligible patients were matched 1:1 based on propensity scores for the presence or absence of TDT. Postoperative outcomes and complications were compared between TDT and non-TDT groups. Of 299 cases collected, 252 were eligible for inclusion. After propensity score matching, 166 patients (83 per group) were included. In the TDT group, there was a significant delay in urinary catheter removal (4.3 ± 0.3 vs. 3.5 ± 0.3 days, P = 0.028) and prolonged hospital stay (20.2 ± 1.1 vs. 17.5 ± 1.1 days, P = 0.027). However, there were no significant differences in the number of anastomotic leakages (grade I, 1 vs. 1; grade II, 2 vs. 1; and grade III, 2 vs. 2; P = 1.000) or other postoperative complications between the groups. In patients in which a temporary ileostomy is created during lower rectal cancer surgery, the need for TDT is considered insignificant.