Transanal tube versus defunctioning stoma after low anterior resection for rectal cancer: network meta-analysis of randomized controlled trials

This is the authors' abstract. We don't add key points for this paper.

Anastomotic leakage (AL), one of the feared complications after low anterior resection (LAR), has been reported to be as high as 20 per cent for LAR1. AL may result in poorer oncological outcomes and increased mortality2. As such, several methods have been explored to minimize the risk of AL in patients undergoing LAR for rectal cancer, principally by diverting the flow of faeces or by reducing the intraluminal pressure of the bowel3,4. Diverting stoma (DS) is one of the widely used methods. However, it is not without its disadvantages; stoma-related complications, poorer quality of life, increased cost, need for reoperation, and more frequent hospitalizations5. To avoid the drawbacks of DS, there has been relatively long-standing interest within the surgical community in the use of a transanal tube (TT) to reduce intraluminal pressure, as well as faecal diversion, resulting in a protective effect on anastomotic healing. Although there have been isolated reports of rectal perforation6, TT placement is a generally safe procedure in experienced hands. More common disadvantages of TT placement include perianal excoriations and early dislodgement7. The aim of this study was to undertake a systematic review and network meta-analysis of randomized controlled trials (RCTs) to compare the different strategies in preventing AL in patients undergoing LAR for rectal cancer.