title: Effectiveness of a transanal tube for the prevention of anastomotic leakage after rectal cancer surgery.
abstract: OBJECTIVE
  We evaluated the effectiveness and safety of a transanal tube placed for the prevention of anastomotic leakage after rectal surgery.
  
  
  METHODS
  Between 2007 and 2011, a total of 243 patients underwent anterior resection using the double stapling technique for rectal cancer at our institution. We excluded 67 patients with diverting stoma and divided the remaining patients into two groups: patients who did not receive a transanal tube and diverting stoma (n = 140; control group) and those who received a transanal tube (n = 36). We compared the rate of anastomotic leakage, evaluated the complications associated with the transanal tube, and analyzed the risk factors for anastomotic leakage.
  
  
  RESULTS
  The following perioperative parameters were significantly different between the two groups as follows (control group vs. transanal tube group): diabetes mellitus (8 [22 %] vs. 12 [8.5 %] patients, respectively; p = 0.03), surgical duration (262 ± 54.1 min [171-457] vs. 233 ± 61.7 min [126-430], respectively; p < 0.01). The postoperative anastomosis leakage appeared significantly different between the two groups (1 [2.7 %] vs. 22 [15.7 %] patients, respectively; p = 0.04). Anastomotic leakage was significantly associated with the distance between the anastomosis line and the anal verge (odds ratio [OR] 8.58; 95 % confidence interval [CI] 1.53-48.0; p = 0.01) and non-use of a transanal tube (OR 11.1; 95 % CI 1.04-118; p = 0.04) in both univariate and multivariate analyses.
  
  
  CONCLUSIONS
  Placement of a transanal tube is effective in decreasing the rate of anastomotic leakage after anterior resection using the double stapling technique. However, complications associated with a transanal tube should be carefully considered.
authors.affiliation: Colorectal and Pelvic Surgery Division, Department of Surgical Oncology, National Cancer Center Hospital East, Kashiwanoha 6-5-1, Kashiwa, Chiba, 277-8577, Japan, nishigori.hideaki@shinkohp.or.jp.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nishigori
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ito
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nishizawa
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Nishizawa
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kobayashi
authors.forename: Masanori
authors.initials: M
authors.lastname: Sugito
authors.forename: Norio
authors.initials: N
authors.lastname: Saito
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control*; D012809:Colon, Sigmoid / Q000601:surgery*; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques