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The usefulness of transanal tube for reducing anastomotic leak in mid rectal cancer: compared to diverting stoma

Annals of Surgical Treatment and Research 2021년 100권 2호 p.100 ~ 108
조석현, 이인규, 이윤석, 김민기,
소속 상세정보
조석현 ( Cho Seok-Hyeon ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Surgery
이인규 ( Lee In-Kyu ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Surgery
이윤석 ( Lee Yoon-Suk ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Surgery
김민기 ( Kim Min-Ki ) - Hanyang University College of Medicine Myongji Hospital Department of Surgery

Abstract


Purpose: Diverting stoma (DS) and transanal tube (TAT) are the 2 main procedures for reducing anastomotic leak (AL) in rectal cancer surgery. However, few studies have compared the protective effect of the 2 modalities against AL.

Methods: Total of 165 patients with mid rectal cancer, who underwent curative resection from 2012 to 2017, were included. Clinical characteristics and outcomes were compared. Risk factors for AL were identified using multivariate analysis.

Results: The DS group had lower tumor location, higher rates of neoadjuvant concurrent chemoradiotherapy, and longer operative time than the TAT group. However, the level of the anastomosis did not show statistically significant differences (DS: 4.6 cm vs. TAT: 4.9 cm, P = 0.061). AL occurred in 14 of the 165 patients (8.5%), with 10 (10.2%) in the DS group and 4 (6.0%) in the TAT group (P = 0.405). On multivariate analysis, only low body mass index (BMI) and smoking were significantly related to AL. Neither the protection method nor neoadjuvant chemoradiotherapy demonstrated statistical differences in AL. Seven of 10 patients in the DS group who experienced AL were treated conservatively, while all 4 in the TAT group underwent reoperation.

Conclusion: TAT seems to have comparable protective effect against AL to DS. However, in AL, DS appeared to be more effective in preventing reoperation. Therefore, DS is recommended in patients with low BMI or smoking, and with an expected higher probability of morbidity or mortality in case of reoperation. In other cases, TAT may be considered as an alternative to DS.

키워드

Anastomotic leak; Rectal neoplasms; Surgical stomas

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