eP380 - Novel Management for Transanal Drainage Tube Based on Postoperative C-Reaction Protein Trajectory to Prevent Anastomotic Leak After Laparoscopic Rectal Surgery

Purpose/Background: Placement of an indwelling transanal drainage tube (TDT) to prevent anastomotic leak (AL) after anterior rectal resection is still controversial. One potential reason lies in the neglect of specific indwelling time of the TDT, leading to premature removal of the TDT even before occurrence of AL. Postoperative C-reaction protein (CRP) trajectory has a high negative predictive value for ruling out AL and may help to maximize the effect of TDT placement on AL prevention.Methods/Interventions: A prospective cohort of patients who underwent laparoscopic anterior rectal resection because of rectal cancer with routine TDT placement (silicone, 28Fr) and no preventive stoma were included. The tip of TDT was placed approximately 5cm above the anastomosis. CRP was tested everyday postoperatively. CRP level exceeding 50 mg/l between any two postoperative days when other potential infections were excluded was defined as risk trajectory of AL. Patients without risk trajectory of CRP or sign of AL were allowed liquid diet on postoperative day 3 (POD 3) and TDT was removed on POD 5. In presence of risk trajectory or sign of AL before POD 5, liquid diet was ceased or not allowed, until POD 7 or later on condition that CRP had started to decline and no sign of AL existed, and TDT was removed two days later. In case of AL, TDT was not removed until healing for Grade A and B AL or emergency surgery for Grade C AL (Figure).Results/Outcomes: Overall, 52 rectal cancer patients (tumor staging I-III) without neoadjuvant chemo- or radiotherapy were included (28 males, 24 females). The mean age and BMI were (64.5±9.2) years and (25.2±3.2) kg/m2. All anastomoses were above the level of levator ani and were performed by double-stapling technique. The distance between anal verge and anastomosis was (5.1±0.9) cm and all anastomoses were palpable by digital rectal examination. Of all 52 patients, 30 patients showed no risk trajectory of CRP and were discharged on POD 6; TDT was intolerable in 2 patients and was removed prematurely on POD 3. In the other 22 patients, the mean indwelling time of TDT was (9.1±1.4) days. Two male patients showed AL (Grade B) on POD 5 and 6 and were both healed with conservation therapy. No other AL were observed during follow-up. The total incidence of AL was 3.8%. No TDT-related complications occurred.Conclusion/

Discussion: For mid-low anastomosis without preventive stoma after laparoscopic anterior rectal resection, postoperative CRP trajectory-based TDT management is a safe strategy achieving favorable outcomes in controlling anastomotic leak.Figure