PARLAR-02 Trial：Modified Transanal Drainage Tube Use for Preventing Anastomotic Leakage

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

Sex

All

Minimum age

18 Years

Maximum age

80 Years

Inclusion Criteria:

* 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 ;
* After assessment, laparoscopic/robotic sphincter - preserving surgery for rectal cancer is feasible;
* T2 - 4N0 - 2M0\~T0 - 1N1 - 2M0 \& non- local recurrence;
* Signed informed consent form;
* Able to understand the risks of participating in the trial.

Exclusion Criteria:

* 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;
* Pregnant or breastfeeding women;
* Bowel obstruction before surgery；
* BMI ≥35.0

• RESULTZhao S, Zhang L, Gao F, Wu M, Zheng J, Bai L, Li F, Liu B, Pan Z, Liu J, Du K, Zhou X, Li C, Zhang A, Pu Z, Li Y, Feng B, Tong W. Transanal Drainage Tube Use for Preventing Anastomotic Leakage After Laparoscopic Low Anterior Resection in Patients With Rectal Cancer: A Randomized Clinical Trial. JAMA Surg. 2021 Dec 1;156(12):1151-1158. doi: 10.1001/jamasurg.2021.4568. PMID 34613330