A Comparison of Transanal Drainage Tube and Diverting Ileostomy Following Low Anterior Resection for Rectal Cancer.

INTRODUCTION

Diverting ileostomy (DS) and transanal drainage tube (TDT) are two common strategies to protect the anastomosis after low anterior resection (LAR). This study aimed to compare outcomes between patients receiving either a DS or a TDT following LAR.

METHODS

In this retrospective cohort study, we included eligible patients with rectal cancer who underwent LAR between March 2021 and February 2025 at our centers and had no history of neoadjuvant radiotherapy. Hospital length of stay, as a short-term outcome, and long-term outcomes--including low anterior resection syndrome (LARS) score and quality of life (QoL)-were compared between the DS and TDT groups.

RESULTS

Among 74 eligible patients (52.7% men), 24 were in the TDT group and 50 in the DS group. Compared with the DS group, the TDT group had a significantly shorter hospital stay (P<0.001) and a better LARS score (P=0.004). Multivariable logistic regression analysis adjusted for age and sex revealed that DS was independently associated with increased odds of LARS (OR=4.92, 95% CI: 1.51-16.09). There were no significant differences between the groups regarding most QoL domains.

CONCLUSION

For patients undergoing LAR for rectal cancer without neoadjuvant radiotherapy, TDT placement was associated with a shorter hospital stay and better long-term bowel function.