Rectal cancer surgery has become increasingly effective, allowing many patients to avoid permanent colostomy. However, anastomotic leakage remains one of the most serious complications after rectal cancer surgery, especially in patients undergoing low anterior resection. Anastomotic leakage may lead to pelvic infection, prolonged hospitalization, additional treatments, and may affect the recovery of temporary diverting stomas.
This investigator-initiated clinical study aims to evaluate the safety and potential effectiveness of local methylene blue injection around the pelvic floor after completion of colorectal anastomosis in patients with high-risk rectal cancer undergoing low anterior resection with a temporary diverting ileostomy.
In this study, eligible patients will receive local injection of diluted methylene blue solution into the pelvic floor muscles surrounding the anastomosis after surgery. Participants will be followed for 12 months after surgery. The study will evaluate postoperative outcomes, including the occurrence of anastomotic leakage, complications related to the injection procedure, and whether the temporary stoma can be successfully reversed.
The information collected in this study may help determine whether local methylene blue injection is a safe and feasible approach for reducing postoperative complications and improving recovery after rectal cancer surgery.
Adults aged 18 years or older with histologically confirmed rectal adenocarcinoma.
Patients with mid or low rectal cancer (tumor located within 10 cm from the anal verge) who are scheduled to undergo curative low anterior resection with a temporary diverting ileostomy.
Patients with one or more risk factors associated with postoperative stoma non-closure or anastomotic complications, including male sex, narrow pelvis, neoadjuvant chemoradiotherapy, prolonged operative time, or increased intraoperative bleeding risk.
Patients who are considered suitable candidates for surgery and postoperative follow-up according to the investigator's assessment.
Patients with emergency surgical conditions, including intestinal obstruction, bowel perforation, or acute abdominal infection before surgery.
Patients undergoing abdominoperineal resection, local excision, or other surgical procedures without colorectal anastomosis and diverting ileostomy.
Patients with other active malignancies or recurrent rectal cancer. Patients who are unable to tolerate the planned surgery or follow-up procedures.
Patients with contraindications or known hypersensitivity to methylene blue injection.
Single group
methylene blue injection
DrugEligible patients have mid-low locally advanced rectal adenocarcinoma (≤10 cm from anal verge) with at least one risk factor for stoma non-closure, scheduled for low anterior resection with defunctioning ileostomy. After anastomosis, 20 mL of 0.1% methylene blue is injected into the pelvic floor muscles.
Proportion of participants with successful stoma closure within 12 months after surgery
Successful stoma closure is defined as reversal of the temporary diverting ileostomy within 12 months after low anterior resection. The outcome will be reported as the proportion of participants who undergo stoma closure among all enrolled participants.
Number of participants with postoperative surgical complications within 30 days after surgery
Postoperative surgical complications will be assessed within 30 days after surgery and reported as the number and proportion of participants experiencing at least one complication. Complications will be graded according to the Clavien-Dindo classification system. Assessed complications include, but are not limited to, anastomotic leakage, surgical site infection, bleeding, ileus, and other surgery-related complications.
Number of participants with methylene blue-related adverse events within 30 days after surgery
Methylene blue-related adverse events will be within 30 days after surgery and reported as the number and proportion of participants experiencing adverse events considered related to local methylene blue injection. Assessed events include local tissue irritation, injection-site pain, tissue necrosis, allergic reactions, and other unexpected adverse events related to methylene blue administration.
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