Prophylactic transanal decompression tube versus non-prophylactic transanal decompression tube for anastomotic leakage prevention in low anterior resection for rectal cancer: a meta-analysis.
Transanal decompression tube (TDT), an alternative intervention believed to have potential equivalent efficacy in reducing anastomotic leakage after rectal cancer surgery and lower complication rates compared to protective stoma, was sporadically applied in some medical centers during recent decade. The objective of this meta-analysis was to evaluate the effect of the TDT in preventing the anastomotic leakage after low anterior resection for rectal cancer.



The studies comparing TDT and non-TDT in rectal cancer were researched up to March 22, 2016 without language preference, in databases of PubMed, Web of Science, Cochrane library, International Clinical Trials Registry Platform, and National Clinical Trials Registry. The rates of anastomotic leakage, bleeding, and re-operation were separately calculated and compared between TDT and non-TDT groups using RevMan 5.3. Funnel plots, and Egger's tests were used to evaluate the publication biases of the studies.



Two prospective randomized controlled trial studies and five observational cohort studies with 833 participants in TDT group and 939 participants in non-TDT group were finally included in this meta-analysis. The results indicated that the TDT group had lower anastomotic leakage rate than non-TDT group with significant RR (RR 0.44; 95 % CI 0.29-0.66; P < 0.0001) and heterogeneity (I2= 33 %; P = 0.18). So did the re-operation rate, with RR (RR 0.16; 95 % CI 0.07-0.37; P < 0.0001) and heterogeneity among the studies (I2= 0 %; P = 0.80). There was no significant difference in anastomotic bleeding rates (RR 1.48; 95 % CI 0.79-2.77; P = 0.22) (I2= 58 %; P = 0.09). No publication bias was found by Egger's test (anastomotic leakage rate, Pr > |z| = 0.224; re-operation rate, Pr > |z| = 0.425).



TDT might be an efficient and economic intervention in preventing anastomotic leakage after rectal cancer surgery.
Department of Gastrointestinal Surgery, West China School of Medicine, Sichuan University/West China Hospital, Chengdu Shangjin Nanfu, Chengdu, 610041, Sichuan Province, China.
Yun
Y
Yang
Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Lane, Chengdu, 610041, Sichuan Province, China.
Ye
Y
Shu
Department of Epidemiology, University of Florida, Gainesville, FL, USA.
Fangyu
F
Su
Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Lane, Chengdu, 610041, Sichuan Province, China.
Lin
L
Xia
Department of Oncology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
Baofeng
B
Duan
Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Lane, Chengdu, 610041, Sichuan Province, China. drwxt1957@gmail.com.
Xiaoting
0000-0002-1284-7749
X
Wu
D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D064887:Observational Studies as Topic; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome
Anastomotic leakage; Low anterior resection; Rectal cancer; Transanal decompression tube