Updated evidence of the effectiveness and safety of transanal drainage tube for the prevention of anastomotic leakage after rectal low anterior resection: a systematic review and meta-analysis.
K Tamura, M Uchino, S Nomura, S Shinji, K Kouzu, T Fujimoto, K Nagayoshi, Y Mizuuchi, H Ohge, S Haji, J Shimizu, Y Mohri, C Yamashita, Y Kitagawa, K Suzuki, M Kobayashi, M Kobayashi, M Yoshida, T Mizuguchi, T Mayumi, Y Kitagawa, M Nakamura
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引用次数: 0
Abstract
Backgrounds: Anastomotic leakage (AL) represents a major complication after rectal low anterior resection (LAR). Transanal drainage tube (TDT) placement offers a potential strategy for AL prevention; however, its efficacy and safety remain contentious.
Methods: A systematic review and meta-analysis were used to evaluate the influence of TDT subsequent to LAR as part of the revision of the surgical site infection prevention guidelines of the Japanese Society of Surgical Infectious Diseases (PROSPERO registration; CRD42023476655). We searched each database, and included randomized controlled trials (RCTs) and observational studies (OBSs) comparing TDT and non-TDT outcomes. The main outcome was AL. Data were independently extracted by three authors and random-effects models were implemented.
Results: A total of three RCTs and 18 OBSs were included. RCTs reported no significant difference in AL rate between the TDT and non-TDT groups [relative risk (RR): 0.69, 95% confidence interval (CI) 0.42-1.15]. OBSs reported that TDT reduced AL risk [odds ratio (OR): 0.45, 95% CI 0.31-0.64]. In the subgroup excluding diverting stoma (DS), TDT significantly lowered the AL rate in RCTs (RR: 0.57, 95% CI 0.33-0.99) and OBSs (OR: 0.41, 95% CI 0.27-0.62). Reoperation rates were significantly lower in the TDT without DS groups in both RCTs (RR: 0.26, 95% CI 0.07-0.94) and OBSs (OR: 0.40, 95% CI 0.24-0.66). TDT groups exhibited a higher anastomotic bleeding rate only in RCTs (RR: 4.28, 95% CI 2.14-8.54), while shorter hospital stays were observed in RCTs [standard mean difference (SMD): -0.44, 95% CI -0.65 to -0.23] and OBSs (SMD: -0.54, 95% CI -0.97 to -0.11) compared with the non-TDT group.
Conclusions: A universal TDT placement cannot be recommended for all rectal LAR patients. Some patients may benefit from TDT, such as patients without DS creation. Further investigation is necessary to identify the specific beneficiaries.
背景：吻合口漏（AL）是直肠低位前切除术（LAR）后的主要并发症。经肛门引流管（TDT）置入是一种潜在的预防 AL 的策略，但其有效性和安全性仍存在争议：作为日本外科传染病学会手术部位感染预防指南（PROSPERO 注册；CRD42023476655）修订工作的一部分，我们采用了系统回顾和荟萃分析的方法来评估经肛门引流管对 LAR 术后的影响。我们检索了每个数据库，并纳入了比较 TDT 和非 TDT 结果的随机对照试验 (RCT) 和观察性研究 (OBS)。主要结果为AL。数据由三位作者独立提取，并采用随机效应模型：结果：共纳入了 3 项 RCT 和 18 项 OBS。RCT报告称，TDT组和非TDT组的AL率无明显差异[相对风险（RR）：0.69，95%置信区间（CI）0.42-1.15]。OBS 报告称，TDT 降低了 AL 风险[几率比 (OR)：0.45，95% 置信区间 (CI)：0.31-0.64]。在不包括分流造口（DS）的亚组中，RCT（RR：0.57，95% CI 0.33-0.99）和OBS（OR：0.41，95% CI 0.27-0.62）中的TDT显著降低了AL率。在 RCT（RR：0.26，95% CI 0.07-0.94）和 OBS（OR：0.40，95% CI 0.24-0.66）中，无 DS 的 TDT 组的再手术率都明显较低。仅在RCTs（RR：4.28，95% CI 2.14-8.54）中，TDT组的吻合口出血率较高，而与非TDT组相比，在RCTs[标准平均差（SMD）：-0.44，95% CI -0.65至-0.23]和OBSs（SMD：-0.54，95% CI -0.97至-0.11）中观察到较短的住院时间：结论：不能建议所有直肠 LAR 患者都使用 TDT。结论：不能建议所有直肠 LAR 患者都使用通用的 TDT。有必要进行进一步调查，以确定具体的受益者。
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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