Surgical resection remains the primary treatment for rectal cancer, but the postoperative incidence of anastomotic leakage (AL) is relatively high. AL not only increases the medical burden on patients, prolongs hospital stays, raises the need for secondary surgery, and elevates perioperative mortality, but also increases the long-term risk of local recurrence and reduces survival rates. There is an urgent need for a simple, effective treatment method that minimizes the burden on patients to prevent anastomotic leakage.
The preoperative placement of a transanal drainage tube (TDT) is believed to effectively drain gas and feces from the intestinal lumen, thereby reducing intestinal pressure and alleviating tension at the anastomotic site, thus preventing AL. Previous studies have shown that traditional drainage tubes cannot effectively prevent leakage. Given the limitations of existing research on traditional TDTs, we plan to use a modified TDT (which allows postoperative irrigation and utilizes a balloon to block feces from adversely affecting the anastomosis) to conduct a randomized, parallel-controlled trial. This study aims to further investigate the role of the modified TDT in preventing and treating anastomotic leakage following rectal surgery
Rectal adenocarcinoma (confirmed by pathology);
Tumor location: The lower edge is ≤10 cm from the anal verge;
Age: ≥18 and ≤80 years old;
ASA ≤3 ;
Emergency surgery;
Presence of multiple primary colorectal cancers;
History of long - term use of immunosuppressants or corticosteroids;
Patients with severe mental illness or uncontrolled infection before surgery;
Parallel
Modified Transanal Drainage Tube
DevicePatients with rectal adenocarcinoma will undergo elective laparoscopic/robotic low anterior resection. After the anastomosis is completed and the air leak test is confirmed to be negative, a modified TDT (occlusive balloon catheter) will be inserted. The balloon will be placed 5 cm above the anastomosis and filled under laparoscopic visualization (approximately 25 ml) to slightly dilate the intestinal lumen and occlude the intestinal cavity (under laparoscopic monitoring to ensure it does not affect the blood supply of the intestine). The external part of the tube will be sutured to the perianal skin and further secured with a 3M transparent dressing on the outside. It will be connected to a drainage bag (with an inner diameter greater than 8 mm) and left in place for 7 days, or until the drainage function is lost due to obvious defecation around the anal tube, at which point the catheter will be removed.
Incidence of AL
The incidence of total anastomotic leakage within 30 days after surgery
Grades of AL
Classification of anastomotic leakage: Grade A is asymptomatic and detected by imaging only; Grade B requires specific interventions but not surgical treatment; Grade C requires surgical treatment.
Incidence of anastomosis-related complications
The overall incidence of anastomosis-related complications within 12 months after surgery.
3y-DFS AND LRR
Three-year disease-free survival (DFS) and local recurrence rate.
Perianal pain assessment score
Numerical Rating Scale (NRS) \[0-10 scale\]: No pain (0); Mild pain (1-3); Moderate pain (4-6); Severe pain (7-10)
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