Correlation between Colon Perfusion and Postoperative Fecal Output through a Transanal Drainage Tube during Laparoscopic Low Anterior Resection

Kenji Kawada; Toshiaki Wada; Takehito Yamamoto; Yoshiro Itatani; Koya Hida; Kazutaka Obama

doi:10.3390/cancers14092328

Correlation between Colon Perfusion and Postoperative Fecal Output through a Transanal Drainage Tube during Laparoscopic Low Anterior Resection

Cancers (Basel). 2022 May 8;14(9):2328. doi: 10.3390/cancers14092328.

Authors

Kenji Kawada¹, Toshiaki Wada^{1

2}, Takehito Yamamoto^{1

3}, Yoshiro Itatani¹, Koya Hida¹, Kazutaka Obama¹

Affiliations

¹ Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan.
² Department of Surgery, Faculty of Medicine, Kindai University, Osaka 589-8511, Japan.
³ Department of Gastroenterological Surgery and Oncology, Kitano Hospital Medical Research Institute, Osaka 530-8480, Japan.

Abstract

In order to prevent anastomotic leakage (AL) following rectal surgery, various solutions—such as intraoperative indocyanine green (ICG) angiography and transanal drainage tubes (TDT)—have been proposed. This study investigated the relationship between intestinal perfusion and fecal volume through TDT in laparoscopic low anterior resection (LAR). A total of 59 rectal cancer patients who underwent laparoscopic LAR with both intraoperative ICG angiography and postoperative TDT placement were retrospectively analyzed. The relationship between intestinal perfusion and fecal volume through TDT was examined. Based on the ICG fluorescence, the transection site was shifted more proximally in 20 cases (33.9%). Symptomatic AL occurred in seven patients (11.8%). The AL rate of the patients whose daily fecal volume exceeded 100 mL/day in 2 or more days was significantly higher than that of those whose daily fecal volume exceeded it in 0 or 1 day (44.4% vs. 6.0%; p < 0.01). Univariate and multivariate analyses showed that the need for a proximal shift of the transection site was significantly associated with a high fecal volume. The quantitative analysis of ICG fluorescence indicated that Fmax (the fluorescence difference between the baseline and maximum) was significantly associated with fecal volume through TDT.

Keywords: ICG angiography; anastomotic leakage; rectal cancer; transanal drainage tube.

Grants and funding

This work was supported by grants from the Ministry of Education, Culture, Sports, Science and Technology of Japan (to K. Kawada, grant number 22K08770).