Utility of Transanal Tube for Preventing Severe Anastomotic Leakage Following Low Anterior Resection for Patients With Diverting Stoma

The incidence of anastomotic leakage (AL) associated with sphincter-preserving surgery has increased. Diverting stoma (DS) and transanal tube (TT) placement have been reported to reduce the rate of AL. This multicenter study examined the efficacy of TT and DS for preventing AL in rectal cancer patients. We reviewed 126 patients who underwent low anterior resection with double-stapling reconstruction between April 2016 and March 2020. Patients were divided into 2 groups according to presence (n = 90) or absence (n = 36) of a TT. Clinicopathologic features were compared between groups. Twenty-one patients (16.7%) experienced AL. Frequency of severe AL was significantly lower in the TT group (7.7%) than in the non-TT group (19.4%, P < 0.001). Performance status, operation time, blood loss, and hospital stay were similar between groups. Patients who experienced AL showed significantly longer hospital stays (29 days versus 15 days, P < 0.001). Multivariate analysis revealed placement of a TT as an independent predictor of no AL (odds ratio, 0.306; 95% confidence interval, 0.108–0.870; P = 0.026). Twenty-one patients received both DS construction and TT placement; none of them experienced severe AL. The present multicenter study confirmed the efficacy of TT for preventing AL. Transanal tube may have synergistic effects against AL in selected patients with DS.