Transanal tube for the prevention of anastomotic leakage in rectal cancer surgery.
Hidetaka Kawamura, Yasushi Tsujimoto, Teppei Miyakawa et al.
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In 30 seconds
This systematic review and meta-analysis evaluated the effectiveness of a transanal tube in preventing anastomotic leakage in rectal cancer surgery, involving 1318 participants across four randomized controlled trials. The results indicated a very low-certainty evidence with a risk ratio of 0.88 for anastomotic leakage, suggesting no significant benefit. However, among patients without a diverting stoma, the risk ratio for surgical re-intervention was 0.25, indicating potential benefit in this subgroup.
Key findings
- Risk ratio for anastomotic leakage with transanal tube was 0.88 (95% CI 0.46 to 1.72).
- Among patients without a diverting stoma, the risk ratio for surgical re-intervention was 0.25 (95% CI 0.07 to 0.94).
- Anticipated absolute risk of surgical re-intervention was 14 per 1000 in the transanal tube group.
- The effect of the transanal tube varied significantly based on diverting stoma status (P = 0.03).
Why it matters
Anastomotic leakage is a significant complication in rectal cancer surgery, leading to increased morbidity and healthcare costs. Understanding the potential benefits and risks of interventions like the transanal tube can inform surgical decision-making and patient management.
What to keep in mind
The overall certainty of evidence was very low due to risk of bias, inconsistency, and imprecision in the included studies.