Role of transanal tube placement in preventing anastomotic leakage in rectal cancer surgery with sufficient perfusion confirmed by indocyanine green fluorescence imaging.

BACKGROUND: Anastomotic leakage (AL) remains a major complication after rectal cancer surgery. Although various techniques have been proposed to reduce its incidence, the effectiveness of transanal tube (TA) placement remains controversial. This study aimed to evaluate whether combining indocyanine green (ICG) fluorescence angiography with TA placement reduces the risk of AL after rectal cancer surgery.

METHODS: A retrospective analysis, including patients who underwent rectal resection with primary anastomosis for rectal cancer, was performed. In all cases, anastomotic perfusion was assessed intraoperatively using ICG fluorescence angiography. Patients were categorized into two groups on the basis of postoperative TA placement: TA group and non-TA group. The primary outcome was the incidence of AL. Multivariate logistic regression and subgroup analyses based on tumor location were performed.

RESULTS: The TA group demonstrated a significantly lower incidence of AL compared with the control group (5% versus 18%, p = 0.02). Multivariate analysis identified male sex as a risk factor and TA placement as a protective factor for AL. Subgroup analysis revealed that TA placement was particularly effective in patients with middle rectal cancer.

CONCLUSIONS: The placement of a TA may offer additional benefit in reducing the risk of AL after rectal cancer surgery when adequate perfusion is confirmed using ICG fluorescence imaging, particularly in cases of middle rectal cancer.