title: Efficacy of transanal tube placement after anterior resection for rectal cancer: a systematic review and meta-analysis.
abstract: BACKGROUND
  Anastomotic leakage is a serious complication that can occur after anterior resection of the rectum. There is a question regarding whether the placement of a transanal tube can decrease the rate of anastomotic leakage. The aim of this systematic review and meta-analysis was to evaluate the efficacy of transanal tube placement after anterior resection.
  
  
  METHODS
  We searched three major databases (PubMed, Embase, and the Cochrane Library) up until January 2015 for studies evaluating the benefit of transanal tubes after anterior resection for rectal cancer. The primary outcome measure was the rate of clinical anastomotic leakage. Secondary outcome was the rate of reoperation. Pooled risk ratios (RR) with 95% confidence intervals (CI) were obtained using random effects models.
  
  
  RESULTS
  One randomized controlled trial and three observational studies involving 909 patients met inclusion criteria. Clinical anastomotic leakage occurred in 3.49% (14 of 401) of patients with transanal tubes and 12.01% (61 of 508) of patients without transanal tubes. Meta-analysis of the studies showed a lower risk of anastomotic leakage (RR, 0.32; 95% CI 0.18-0.58) and reoperation related to leakage (RR, 0.19; 95% CI 0.08-0.46) when the transanal tube was placed.
  
  
  CONCLUSIONS
  While studies are few and mostly observational, the data to date indicate that placement of a transanal tube decreases the rate of clinical anastomotic leakage and reoperation related to leakage. More studies are needed to confirm these findings.
authors.affiliation: Department of Gastrointestinal surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, China. knight01030103@126.com.
authors.forename: Shuanhu
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Gastrointestinal surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, China.
authors.forename: Zongbing
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Gastrointestinal surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, China.
authors.forename: Mulin
authors.initials: M
authors.lastname: Liu
authors.affiliation: Department of Gastrointestinal surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, China.
authors.forename: Shiqing
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Gastrointestinal surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, China.
authors.forename: Congqiao
authors.initials: C
authors.lastname: Jiang
mesh_terms: D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D012004:Rectal Neoplasms / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome
keywords: Anastomotic leakage; Rectal cancer; Transanal tube